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posted 8:43 p.m.
Friday, November 02, 2007
Sunday, December 31, 2006
Description DID
This page is devoted to a description of causes and symptoms for DID and PTSD. If the content is too "medical", simpler explanations can be found in For Survivors.
SITE MAP DID : Different DSM-IV Diagnoses : For Survivors : Q & A : Survivors’ Stories :
SITE MAP DID : Different DSM-IV Diagnoses : For Survivors : Q & A : Survivors’ Stories :
posted 11:59 p.m.
Dissociative Identity Disorder
Despite being both common and reversible, Dissociative Identity Disorder frequently goes undiagnosed and untreated.
Unfortunately, people are often frightened of this condition because they they identify this diagnosis with those cases that exist on the extreme end of the spectrum of dissociative symptoms and behaviours.
In the simplest analysis, people have one identity or more than one identity. However, this simple dichotomy, which is too often denied by health and mental health professionals, is too narrow to describe the spectrum of manifestations of dissociative identity systems. This site will attempt to clarify the range of manifestations of DID.
Unfortunately, people are often frightened of this condition because they they identify this diagnosis with those cases that exist on the extreme end of the spectrum of dissociative symptoms and behaviours.
In the simplest analysis, people have one identity or more than one identity. However, this simple dichotomy, which is too often denied by health and mental health professionals, is too narrow to describe the spectrum of manifestations of dissociative identity systems. This site will attempt to clarify the range of manifestations of DID.
posted 11:59 p.m.
prevalence
Reported prevalence (frequency) varies from one study to another. Most studies report prevalence of 1 to 4% of the population. Several studies uncovered previously undiagnosed dissociative identity disorder in 3 to 4% of acute psychiatric inpatients. With increased awareness amongst mental health professionals, the reported prevalence is rising.
DID is diagnosed four times more frequently in women, probably because females seek therapy. Males with DID are more likely to commit violent crimes and to be incarcerated within the penal system.
DID is diagnosed four times more frequently in women, probably because females seek therapy. Males with DID are more likely to commit violent crimes and to be incarcerated within the penal system.
posted 11:58 p.m.
PTSD
Like DID, PTSD develops in response to the experience of traumatic events. Unlike DID, which results from trauma in early childhood, PTSD may develop at any age.
The characteristic symptoms (physiological arousal, avoidance, flashbacks) of PTSD may be present at presentation with DID, or may develop subsequently. While emotionally disturbing, PTSD represents a phase of healing within DID.
The characteristic symptoms (physiological arousal, avoidance, flashbacks) of PTSD may be present at presentation with DID, or may develop subsequently. While emotionally disturbing, PTSD represents a phase of healing within DID.
posted 11:58 p.m.
etiology
Etiology is the medical term for cause, those factors that predispose a person to develop a condition. In the case of DID and PTSD, the cause is trauma. DID develops when repeated, severe trauma occurs during early childhood. PTSD can develop at any age in response to trauma.
THE MERCK MANUAL, Sec. 15, Ch. 188, Dissociative Disorders: "North American studies show that 97 to 98% of adults with dissociative identity disorder report abuse during childhood and that abuse can be documented for 85% of adults and for 95% of children and adolescents with dissociative identity disorder and other closely related forms of dissociative disorder."
THE MERCK MANUAL, Sec. 15, Ch. 188, Dissociative Disorders: "North American studies show that 97 to 98% of adults with dissociative identity disorder report abuse during childhood and that abuse can be documented for 85% of adults and for 95% of children and adolescents with dissociative identity disorder and other closely related forms of dissociative disorder."
posted 11:57 p.m.
diagnosis
The official diagnostic criteria according to the “The Diagnostic and Statistical Manual, 4 th Edition, Text Revision (DSM-IV-TR; American Psychiatric Association, 2000a)” are:
A. The presence of two or more distinct identities or personality states (each with its own relatively enduring pattern of perceiving, relating to, and thinking about the environment and self).
B. At least two of these identities or personality states recurrently take control of the person's behavior.
C. Inability to recall important personal information that is too extensive to be explained by ordinary forgetfulness.
D. The disturbance is not due to the direct physiological effects of a substance (e.g., blackouts or chaotic behavior during Alcohol Intoxication) or a general medical condition (e.g., complex partial seizures). Note: In children, the symptoms are not attributable to imaginary playmates or other fantasy play.
However, few patients with DID display distinct identities early within therapy, and many deny, or are unaware of, amnesic episodes (time loss).
Because this condition is frequently missed or misdiagnosed, the interviewing clinician must have a high index of suspicion when patients complain of symptoms that are frequently encountered in DID/PTSD.
Useful questions cover the following areas:
A. The presence of two or more distinct identities or personality states (each with its own relatively enduring pattern of perceiving, relating to, and thinking about the environment and self).
B. At least two of these identities or personality states recurrently take control of the person's behavior.
C. Inability to recall important personal information that is too extensive to be explained by ordinary forgetfulness.
D. The disturbance is not due to the direct physiological effects of a substance (e.g., blackouts or chaotic behavior during Alcohol Intoxication) or a general medical condition (e.g., complex partial seizures). Note: In children, the symptoms are not attributable to imaginary playmates or other fantasy play.
However, few patients with DID display distinct identities early within therapy, and many deny, or are unaware of, amnesic episodes (time loss).
Because this condition is frequently missed or misdiagnosed, the interviewing clinician must have a high index of suspicion when patients complain of symptoms that are frequently encountered in DID/PTSD.
Useful questions cover the following areas:
Sense of gaps within childhood memories – many patients have extensive periods without memories, and are initially acquainted with little of their personal history.
Having been told often that he/she has done or said something that is not recalled within a reasonable timeframe.
Awareness of losing periods of time – most often noticed in relation to watching television programs. Vague complaints of “difficulty with time” are common.
Sense of saying or doing something outside volitional control.
Sense of having feelings or thoughts that do not belong to his/herself.
Sense of buzzing or ringing in the ears, often accompanied by headache, or hearing voices.
These questions ought to be repeated from time to time as patients may initially deny symptoms out of lack of trust, or may not yet be aware of the symptoms as being unusual.
The clinician’s awareness of the ways in which patients describe their symptoms usually quickly unmasks the rare case of factitious “DID”.
posted 11:56 p.m.
dissociation
Dissociation is a mental process in which the main, host identity is no longer fully aware of the contents of consciousness. This is different than sleep and unconsciousness in that a different segment of the consciousness, an alter identity or personality, is awake and conscious during dissociation.
Dissociative symptoms exist on a spectrum. Dissociation can be partial and result in not feeling fully conscious and in control of thoughts, feelings, and actions. Depersonalization, a sense of not being oneself, is a mild form of dissociation. Highway hypnosis, drifting off into thought during lectures, performing on 'automatic pilot', daydreaming, and deep absorption in a book, or the internet, are all mild forms of dissociation from externals. In essence, the object of consciousness has moved inward and narrowed in such examples.
At other times, dissociation is complete and results in amnesia for events that happened during the dissociative event. This is experienced as a disruption in the continuity of time, resembling the cut from one scene to another that we observe in motion pictures and television dramas. Episodes where the person is unaware of actions, particularly of movement from one locale to another, are often called dissociative fugues, or fugue states.
Dissociative episodes are most often brief, a matter of minutes to hours. However, some survivors with DID experience protracted episodes that may last months.
Dissociative symptoms exist on a spectrum. Dissociation can be partial and result in not feeling fully conscious and in control of thoughts, feelings, and actions. Depersonalization, a sense of not being oneself, is a mild form of dissociation. Highway hypnosis, drifting off into thought during lectures, performing on 'automatic pilot', daydreaming, and deep absorption in a book, or the internet, are all mild forms of dissociation from externals. In essence, the object of consciousness has moved inward and narrowed in such examples.
At other times, dissociation is complete and results in amnesia for events that happened during the dissociative event. This is experienced as a disruption in the continuity of time, resembling the cut from one scene to another that we observe in motion pictures and television dramas. Episodes where the person is unaware of actions, particularly of movement from one locale to another, are often called dissociative fugues, or fugue states.
Dissociative episodes are most often brief, a matter of minutes to hours. However, some survivors with DID experience protracted episodes that may last months.
posted 11:52 p.m.
neural basis for DID and PTSD
The limbic system is the emotion and emotional memory area, and is part of the primitive unconscious brain. It comprises paired structures nestled deep to the cerebral hemispheres, the lobes of the neocortex.
For more information see inside "Brain"
posted 10:00 p.m.
common misdiagnoses
In childhood, the commonest misdiagnosis for DID is ADHD. Childhood Adjustment Disorder is probably the second most frequent misdiagnosis.
Thirty years ago, paranoid schizophrenia appears to have been the most common misdiagnosis for adult patients with DID.
Currently, bipolar affective disorder (formerly called manic-depression) is the commonest misdiagnosis for patients with DID. Obsessive-compulsive disorder, borderline personality disorder, panic disorder, anxiety disorder, temporal lobe epilepsy, and dysthymia (depression lasting more than six months) are other examples of misdiagnoses. All of these conditions, and others, may be co-morbid, coexist with DID, but represent misdiagnoses in the presence of DID. Adult ADHD is becoming increasingly popular as a misdiagnosis.
PTSD is an accurate diagnosis in so far as PTSD is often a component of DID, yet the main diagnostic and therapeutic point has been missed if DID is not also recognized when present.
Thirty years ago, paranoid schizophrenia appears to have been the most common misdiagnosis for adult patients with DID.
Currently, bipolar affective disorder (formerly called manic-depression) is the commonest misdiagnosis for patients with DID. Obsessive-compulsive disorder, borderline personality disorder, panic disorder, anxiety disorder, temporal lobe epilepsy, and dysthymia (depression lasting more than six months) are other examples of misdiagnoses. All of these conditions, and others, may be co-morbid, coexist with DID, but represent misdiagnoses in the presence of DID. Adult ADHD is becoming increasingly popular as a misdiagnosis.
PTSD is an accurate diagnosis in so far as PTSD is often a component of DID, yet the main diagnostic and therapeutic point has been missed if DID is not also recognized when present.
posted 8:50 p.m.
DSM codes
Dissociative Identity ( Multiple Personality) Disorder 300.14
@ http://allpsych.com/disorders/dissociative/did.html
Dissociative Amnesia 300.12
Dissociative Fugue 300.13
Posttraumatic Stress Disorder 309.81
Anxiety Disorders
Dyspareunia 302.76
DSM codes listed at:
http://allpsych.com/disorders/disorders_alpha.html
@ http://allpsych.com/disorders/dissociative/did.html
Dissociative Amnesia 300.12
Dissociative Fugue 300.13
Posttraumatic Stress Disorder 309.81
Anxiety Disorders
Dyspareunia 302.76
DSM codes listed at:
http://allpsych.com/disorders/disorders_alpha.html
posted 1:10 p.m.
Thursday, November 30, 2006
SITE MAP
Description DID : Different DSM-IV Diagnoses : For Survivors : Q & A : Survivors’ Stories :
Description DID :
Dissociative Identity Disorder : prevalence : PTSD :
etiology : diagnosis :
dissociation : symptoms : alter system : voices :
healing : treatment : hypnosis :
neural basis for DID and PTSD :
missed and misdiagnosed : Why is DID misdiagnosed? :
common misdiagnoses : False Memory Syndrome : Why the reluctance to accept the diagnosis? :
Links to websites : terminology : DSM codes :
History of identification of the disorder :
References :
Different DSM-IV Diagnoses
ADHD : Bipolar Affective Disorder : Borderline Personality Disorder : : : : Schizophrenia :
For Survivors :
Q & A :
Survivors’ Stories :
Links :
Research :
Description DID :
Dissociative Identity Disorder : prevalence : PTSD :
etiology : diagnosis :
dissociation : symptoms : alter system : voices :
healing : treatment : hypnosis :
neural basis for DID and PTSD :
missed and misdiagnosed : Why is DID misdiagnosed? :
common misdiagnoses : False Memory Syndrome : Why the reluctance to accept the diagnosis? :
Links to websites : terminology : DSM codes :
History of identification of the disorder :
References :
Different DSM-IV Diagnoses
ADHD : Bipolar Affective Disorder : Borderline Personality Disorder : : : : Schizophrenia :
For Survivors :
Q & A :
Survivors’ Stories :
Links :
Research :
posted 11:59 p.m.
Saturday, June 03, 2006
Friday, December 31, 2004
Bipolar affective disorder
There are a number of Bipolar Affective Disorders based on the latest episode of manic, hypomanic, and depressive episodes.
See:
http://www.mentalhealth.com/dis1/p21-md02.html
Note that DID is not listed among the differential diagnoses, even though DID symptoms can include manic, hypomanic, and depressive episodes.
Society for Neuroscience information on Bipolar
See:
http://www.mentalhealth.com/dis1/p21-md02.html
Note that DID is not listed among the differential diagnoses, even though DID symptoms can include manic, hypomanic, and depressive episodes.
Society for Neuroscience information on Bipolar
posted 11:56 p.m.
Schizophrenia
According to the Society for Neuroscience: "Schizophrenia is a devastating brain disorder that torments sufferers with hallucinations, delusions, disordered thinking patterns, and memory deficits. It is especially tragic because it usually strikes during the late teens, 20s, or early 30s. In the past, many individuals with schizophrenia became permanently lost to the social withdrawal and other behavioral
problems characteristic of this disease."
Unfortunately, this definition fails to differentiate between schizophrenia and DID. One of the important differences is that schizophrenics perceive their hallucinations as having an external origin, while those with DID perceive their voices and flashbacks as having an internal origin. Thought disturbance is prominent in schizophrenia, while any apparent thought disturbance in DID results from intrusions by alters' thoughts.
problems characteristic of this disease."
Unfortunately, this definition fails to differentiate between schizophrenia and DID. One of the important differences is that schizophrenics perceive their hallucinations as having an external origin, while those with DID perceive their voices and flashbacks as having an internal origin. Thought disturbance is prominent in schizophrenia, while any apparent thought disturbance in DID results from intrusions by alters' thoughts.
posted 11:00 p.m.
Wednesday, December 31, 2003
Tuesday, December 31, 2002
Wednesday, October 31, 2001
Survivors' stories
SITE MAP DID : Description DID : Different DSM-IV Diagnoses : For Survivors : Q & A :
If you wish to submit a story, you can email me at gjhardman.md@gmail.com. Those stories or comments that are suitable for the blog will be posted. Please allow at least two weeks for your story to appear on the site. Of course, anonymity will be maintained for any stories that appear.
I apologize that time constraints will prevent my responding personally to questions or comments. If your question might be useful to others, I will post a response on the site. Please allow at least one month for a general answer to your question.
I will neither post nor respond to comments questioning the validity of DID as a diagnosis. The condition exists, and is not merely an artifact of therapy.
If you wish to submit a story, you can email me at gjhardman.md@gmail.com. Those stories or comments that are suitable for the blog will be posted. Please allow at least two weeks for your story to appear on the site. Of course, anonymity will be maintained for any stories that appear.
I apologize that time constraints will prevent my responding personally to questions or comments. If your question might be useful to others, I will post a response on the site. Please allow at least one month for a general answer to your question.
I will neither post nor respond to comments questioning the validity of DID as a diagnosis. The condition exists, and is not merely an artifact of therapy.
posted 11:59 p.m.
Sunday, September 30, 2001
DID: Cognition: The effect of emotional context on cognitive inhibition and attentional processing in dissociative identity disorder.
Entrez PubMed: "In light of previous research, the current study tested the hypothesis that dissociative identity disorder (DID) would be characterised by effective cognitive inhibitory functioning when tested in a neutral context, but weakened inhibition when tested in an emotionally negative context. Using a negative priming task (i.e. the flanker task) to assess inhibitory ability 11 DID, 11 depressed, and 11 general population participants were tested in the two differing experimental contexts. The contexts were manipulated by instructions and word stimuli, and following the completion of this task participants completed the Dissociative Experiences Scale and the Schizotypal Personality Scale. DID participants displayed a greater degree of self-reported anxiety in the negative context and as expected displayed a reduction in inhibition in this context but not in the neutral context. The degree of negative priming for the depressed and general population samples remained stable across contexts as did their anxiety levels. The DID sample displayed slower response times to negative compared to neutral words but this attentional bias was not evident for the two comparison groups. The relationship between increased arousal, inhibitory functioning, dissociation and information processing in DID is discussed."
Dorahy MJ, Middleton W, Irwin HJ.
The effect of emotional context on cognitive inhibition and attentional processing in dissociative identity disorder.
Behav Res Ther. 2005 May;43(5):555-68.
Dorahy MJ, Middleton W, Irwin HJ.
The effect of emotional context on cognitive inhibition and attentional processing in dissociative identity disorder.
Behav Res Ther. 2005 May;43(5):555-68.
posted 11:40 p.m.
PTSD: Pathways to PTSD, part II: Sexually abused children.
Entrez PubMed: "Symptoms measured at the time of disclosure constitute direct, independent pathways by which sexually abused children are likely to develop later PTSD symptoms. These findings speak to the importance of assessing children during the disclosure of abuse in order to identify those at greatest risk for later PTSD symptoms."
Kaplow JB, Dodge KA, Amaya-Jackson L, Saxe GN.
Pathways to PTSD, part II: Sexually abused children.
Am J Psychiatry. 2005 Jul;162(7):1305-10.
Kaplow JB, Dodge KA, Amaya-Jackson L, Saxe GN.
Pathways to PTSD, part II: Sexually abused children.
Am J Psychiatry. 2005 Jul;162(7):1305-10.
posted 11:33 p.m.
DID: Memory: Dissociative identity disorder and memory dysfunction: the current state of experimental research and its future directions.
Entrez PubMed: "Memory dysfunction is a central feature of dissociative identity disorder (DID). Following the memorial anomalies outlined by Putnam [Putnam, F. W. (1994). Dissociation and disturbances of self. In: D. Cicchetti & S. L. Toth (Eds.), Disorders and dysfunctions of the self, vol. 5 (pp. 251-265). Rochester, NY: University of Rochester Press; Putnam, F. W. (1995). Development of dissociative disorders. In: D. Chicchetti & D. J. Cohen (Eds.), Developmental psychopathology, vol. 2 (pp. 581-608). New York: Wiley], the experimental research using DID case studies and samples is reviewed. As a whole, research suggests that amnesic barriers between alter personalities are typically impervious to explicit stimuli, as well as conceptually driven implicit stimuli. Autobiographical memory deficits are also experimentally evident in DID. Although no experimental studies have addressed the issue of source amnesia or pseudomemories, there is some evidence that pseudomemories are an infrequent but real phenomenon in DID patients. Finally, potential deficits in working memory are outlined, including those relating to cognitive inhibition. Research directions are discussed throughout to further elucidate the nature of memory dysfunction in DID."
Dorahy MJ.
Dissociative identity disorder and memory dysfunction: the current state of experimental research and its future directions.
Clin Psychol Rev. 2001 Jul;21(5):771-95.
Dorahy MJ.
Dissociative identity disorder and memory dysfunction: the current state of experimental research and its future directions.
Clin Psychol Rev. 2001 Jul;21(5):771-95.
posted 11:31 p.m.
Dissociation: Cognition: Dissociation, cognitive failures, and working memory.
Entrez PubMed: "The relationships between two personality measures (dissociation and cognitive failures) and different measures of interference from secondary tasks for working memory are investigated. Although the personality and cognitive measures were correlated with one another, canonical and bivariate correlations revealed no systematic relationships between the personality measures and the working memory measures. The upper bounds of the confidence intervals showed that, at most, only 10% of the variance was shared. We discuss the implications for theories of dissociation and cognitive functioning."
Wright DB, Osborne JE.
Dissociation, cognitive failures, and working memory.
Am J Psychol. 2005 Spring;118(1):103-13.
Wright DB, Osborne JE.
Dissociation, cognitive failures, and working memory.
Am J Psychol. 2005 Spring;118(1):103-13.
posted 11:05 p.m.
DID: Bipolar: Dissociative identity disorder associated with mania and change in handedness.
Entrez PubMed: "MRC/UCT Human Genetics Research Unit, University of Cape Town Medical School, Observatory, 7925, South Africa. js@cormack.uct.ac.za
OBJECTIVE: To investigate the overlap between dissociative and bipolar disorders with reference to their neurophysiological foundations. BACKGROUND: Case reports of anomalous lateralization and shifts in handedness associated with both affective and dissociative conditions have intermittently surfaced in the literature. The two disorders are, however, usually considered to be distinct psychopathological entities. METHOD: A case of co-occurring bipolar disorder and dissociative identity disorder (DID) is presented. RESULTS: The 'switch' in personality coincided with manic or hypomanic symptoms and was associated with a change in handedness. CONCLUSIONS: A parallel between the 'personality' shifts that characterize DID and the mood fluctuations that underlie bipolar disorder is drawn, suggesting some nosological overlap between the two disorders. The possibility that these two psychiatric conditions share a similar neurophysiological architecture is also raised."
Savitz J, Solms M, Pietersen E, Ramesar R, Flor-Henry P.
Dissociative identity disorder associated with mania and change in handedness.
Cogn Behav Neurol. 2004 Dec;17(4):233-7.
OBJECTIVE: To investigate the overlap between dissociative and bipolar disorders with reference to their neurophysiological foundations. BACKGROUND: Case reports of anomalous lateralization and shifts in handedness associated with both affective and dissociative conditions have intermittently surfaced in the literature. The two disorders are, however, usually considered to be distinct psychopathological entities. METHOD: A case of co-occurring bipolar disorder and dissociative identity disorder (DID) is presented. RESULTS: The 'switch' in personality coincided with manic or hypomanic symptoms and was associated with a change in handedness. CONCLUSIONS: A parallel between the 'personality' shifts that characterize DID and the mood fluctuations that underlie bipolar disorder is drawn, suggesting some nosological overlap between the two disorders. The possibility that these two psychiatric conditions share a similar neurophysiological architecture is also raised."
Savitz J, Solms M, Pietersen E, Ramesar R, Flor-Henry P.
Dissociative identity disorder associated with mania and change in handedness.
Cogn Behav Neurol. 2004 Dec;17(4):233-7.
posted 10:23 p.m.
DID: Multiple personality disorder: scientific and medicolegal issues.
Entrez PubMed: "Department of Psychiatry, Jewish Hospital of St. Louis, MO 63110.
Despite the intense study it has received since its inclusion in DSM-III, multiple personality disorder (MPD) largely remains an unvalidated construct. Definitional problems remain (there is not even agreement in the field as to whether a diagnosis of MPD truly means the existence of more than one personality), while the vagueness and liberality of existing criteria give the clinician little guidance in diagnosis. In forensic settings, diagnosis of MPD is even more problematic, since there is substantial evidence that the disorder cannot currently be phenomenologically distinguished from malingering. It also remains to be demonstrated that evaluators can determine whether alter personalities, if they exist, are truly unaware of each other, lack control over other alters' behavior, or are unable to know right from wrong."
Dinwiddie SH, North CS, Yutzy SH.
Multiple personality disorder: scientific and medicolegal issues.
Bull Am Acad Psychiatry Law. 1993;21(1):69-79.
Despite the intense study it has received since its inclusion in DSM-III, multiple personality disorder (MPD) largely remains an unvalidated construct. Definitional problems remain (there is not even agreement in the field as to whether a diagnosis of MPD truly means the existence of more than one personality), while the vagueness and liberality of existing criteria give the clinician little guidance in diagnosis. In forensic settings, diagnosis of MPD is even more problematic, since there is substantial evidence that the disorder cannot currently be phenomenologically distinguished from malingering. It also remains to be demonstrated that evaluators can determine whether alter personalities, if they exist, are truly unaware of each other, lack control over other alters' behavior, or are unable to know right from wrong."
Dinwiddie SH, North CS, Yutzy SH.
Multiple personality disorder: scientific and medicolegal issues.
Bull Am Acad Psychiatry Law. 1993;21(1):69-79.
posted 4:44 p.m.
DID: Tx: Toward a psychoanalytic understanding of multiple personality disorder.
Entrez PubMed: "The author suggests a developmental psychoanalytic frame from which to understand the clinical phenomenology of multiple personality disorder (MPD). Annihilation anxiety and fears of nonbeing are understood as central; they are seen as resulting from actual early traumatic impingements at key developmental periods. Alter 'personalities' are conceptualized as functional delusional processes that serve to maintain self-cohesion. The alters are brought about through the subject's lack of capacity for illusion. Some therapeutic implications regarding a psychoanalytic stance are discussed."
Toward a psychoanalytic understanding of multiple personality disorder.
Bull Menninger Clin. 1993 Summer;57(3):309-18.
Reis BE.
Toward a psychoanalytic understanding of multiple personality disorder.
Bull Menninger Clin. 1993 Summer;57(3):309-18.
Reis BE.
posted 4:42 p.m.
DID: Self-rape: Multiple personality: self-rape.
Entrez PubMed: "Multiple personality disorder is the classification given a person for whom two or more distinct personalities are diagnosed. The personalities can be different and vary in character from aggressive to submissive (victimized). The victim alters can be abused and abuse or mutilate self to relieve anxiety or guilt (deserving punishment) or to exert control. Alters may provide a means of expressing anger or other feelings. Aggression towards the body may be sexually oriented, so one may ask whether aggression could make self-rape possible. If so, such expression of self-injuries may be observed in a person with multiple personality as when one alter may injure another. Clinical case material is presented on this concept for a woman who had been formally diagnosed with multiple personality disorder."
Beer D, Beer J, Beer J.
Multiple personality: self-rape.
Psychol Rep. 1994 Dec;75(3 Pt 1):1263-7.
Beer D, Beer J, Beer J.
Multiple personality: self-rape.
Psychol Rep. 1994 Dec;75(3 Pt 1):1263-7.
posted 4:41 p.m.
DID: The characterological basis of multiple personality:
Entrez PubMed: "Philadelphia Psychoanalytic Institute, Pennsylvania Hospital 19139, USA.
This review has focused on the characterological features of dissociative identity disorder (DID), extending the 'state versus trait' debate to the realm of the dissociative disorders. A number of different theories are presented describing DID as a variant of, on a continuum with, or being comorbid with the narcissistic and the borderline personality disorders. It is then hypothesized that DID is best considered a distinct characterological entity. Two theories are put forth, which describe a personality disorder whose predominant defense is dissociation. The more developed model which possibly has more explanatory value is the 'dissociative character.' In this schema, DID would be considered a lower-level dissociative character, utilizing primitive forms of dissociation in which splitting is enhanced by an autohypnotic defensive altered state of consciousness. These altered states originate in response to the overstimulation of external trauma, but get reactivated in the service of here-and-now intrapsychic conflicts. Recognition of this dual quality of dissociation seems helpful in psychodynamic treatment, which allows for analysis of the defense and analysis of the content of these states. The nature of the content of what is 'in dissociation' appears to have a dreamlike quality to it that may correspond to previous trauma but also be subject to some secondary revision. There is clinical evidence to suggest that 'dream work' of the ego is operative in both the representation of a separate self in dreams and in alter personalities. Another organizing influence which contributes to seemingly separate identities is that of perverse sexuality. It appears that a number of dissociated sexual pathways may be followed in the same individual, which encapsulate aggression, childhood trauma, anxiety, and a sense of self. When this exceedingly complex psychic structure is successful, it may then free up some ego to proceed with aspects of healthy development."
Brenner I.
The characterological basis of multiple personality.
Am J Psychother. 1996 Spring;50(2):154-66.
This review has focused on the characterological features of dissociative identity disorder (DID), extending the 'state versus trait' debate to the realm of the dissociative disorders. A number of different theories are presented describing DID as a variant of, on a continuum with, or being comorbid with the narcissistic and the borderline personality disorders. It is then hypothesized that DID is best considered a distinct characterological entity. Two theories are put forth, which describe a personality disorder whose predominant defense is dissociation. The more developed model which possibly has more explanatory value is the 'dissociative character.' In this schema, DID would be considered a lower-level dissociative character, utilizing primitive forms of dissociation in which splitting is enhanced by an autohypnotic defensive altered state of consciousness. These altered states originate in response to the overstimulation of external trauma, but get reactivated in the service of here-and-now intrapsychic conflicts. Recognition of this dual quality of dissociation seems helpful in psychodynamic treatment, which allows for analysis of the defense and analysis of the content of these states. The nature of the content of what is 'in dissociation' appears to have a dreamlike quality to it that may correspond to previous trauma but also be subject to some secondary revision. There is clinical evidence to suggest that 'dream work' of the ego is operative in both the representation of a separate self in dreams and in alter personalities. Another organizing influence which contributes to seemingly separate identities is that of perverse sexuality. It appears that a number of dissociated sexual pathways may be followed in the same individual, which encapsulate aggression, childhood trauma, anxiety, and a sense of self. When this exceedingly complex psychic structure is successful, it may then free up some ego to proceed with aspects of healthy development."
Brenner I.
The characterological basis of multiple personality.
Am J Psychother. 1996 Spring;50(2):154-66.
posted 4:39 p.m.
DID: Tx: Collusion and entanglement in the therapy of a patient with multiple personalities.
Entrez PubMed: "Maharashtra Institute of Mental Health, Pune, India.
S.'s therapy demonstrates some of the ways in which countertransference interferes with therapy of a case presenting with multiple personalities. Fascination with S.'s alter personalities and the desire to prove their genuineness, made her therapist search for them and then repeatedly invoke their appearance. Part of the reason was his inexperience with such cases that induced him to 'play it by the book,' and use 'personality-centered procedures' (looking for a different part, giving it a name, speaking to it, etc.) that have yet to be scientifically validated, instead of adhering to the basic principles of psychotherapy. At a deeper level, however, his excessive preoccupation with S.'s personalities was one kind of collusion with her resistance to deal with the focal issue of her sexual ambivalence. Proof of this resistance also surfaced later as a motivated shift of focus in therapy, and a weakening of the therapeutic alliance. By the time this was evident, sabotage of therapy had already occurred."
Chitalkar Y, Pande N, Shetty J.
Collusion and entanglement in the therapy of a patient with multiple personalities.
Am J Psychother. 1996 Spring;50(2):243-51.
S.'s therapy demonstrates some of the ways in which countertransference interferes with therapy of a case presenting with multiple personalities. Fascination with S.'s alter personalities and the desire to prove their genuineness, made her therapist search for them and then repeatedly invoke their appearance. Part of the reason was his inexperience with such cases that induced him to 'play it by the book,' and use 'personality-centered procedures' (looking for a different part, giving it a name, speaking to it, etc.) that have yet to be scientifically validated, instead of adhering to the basic principles of psychotherapy. At a deeper level, however, his excessive preoccupation with S.'s personalities was one kind of collusion with her resistance to deal with the focal issue of her sexual ambivalence. Proof of this resistance also surfaced later as a motivated shift of focus in therapy, and a weakening of the therapeutic alliance. By the time this was evident, sabotage of therapy had already occurred."
Chitalkar Y, Pande N, Shetty J.
Collusion and entanglement in the therapy of a patient with multiple personalities.
Am J Psychother. 1996 Spring;50(2):243-51.
posted 4:37 p.m.
DID: Vision: Visual function in multiple personality disorder.
Entrez PubMed: "State College of Optometry, State University of New York, NY 10010, USA.
BACKGROUND: Multiple personality disorder (MPD) is characterized by the existence of two or more personality states that recurrently exchange control over the behavior of the individual. Numerous reports indicate physiological differences, including significant differences in ocular and visual function, across alter personality states in MPD. METHODS: The existing literature was reviewed to provide an overview of the nature and characteristics of MPD, with emphasis on reported physiologic and ocular differences across alter personalities. In addition, a case is reported of an MPD patient seen over a 3-year period. RESULTS: Physiologic differences across alter personality states in MPD include differences in dominant handedness, response to the same medication, allergic sensitivities, autonomic and endocrine function, EEG, VEP, and regional cerebral blood flow. Differences in visual function include variability in visual acuity, refraction, oculomotor status, visual field, color vision, corneal curvature, pupil size, and intraocular pressure in the various personality states of MPD subjects as compared to single personality controls. CONCLUSIONS: The possibility of MPDs should be considered in patients who demonstrate unusual variability in ocular and visual findings, particularly with a positive psychiatric history. The existence of visual and other physiologic differences across alter personalities in MPD offers a unique potential for the study of mind-body relationships."
Visual function in multiple personality disorder.
J Am Optom Assoc. 1996 Jun;67(6):327-34.
Birnbaum MH, Thomann K.
BACKGROUND: Multiple personality disorder (MPD) is characterized by the existence of two or more personality states that recurrently exchange control over the behavior of the individual. Numerous reports indicate physiological differences, including significant differences in ocular and visual function, across alter personality states in MPD. METHODS: The existing literature was reviewed to provide an overview of the nature and characteristics of MPD, with emphasis on reported physiologic and ocular differences across alter personalities. In addition, a case is reported of an MPD patient seen over a 3-year period. RESULTS: Physiologic differences across alter personality states in MPD include differences in dominant handedness, response to the same medication, allergic sensitivities, autonomic and endocrine function, EEG, VEP, and regional cerebral blood flow. Differences in visual function include variability in visual acuity, refraction, oculomotor status, visual field, color vision, corneal curvature, pupil size, and intraocular pressure in the various personality states of MPD subjects as compared to single personality controls. CONCLUSIONS: The possibility of MPDs should be considered in patients who demonstrate unusual variability in ocular and visual findings, particularly with a positive psychiatric history. The existence of visual and other physiologic differences across alter personalities in MPD offers a unique potential for the study of mind-body relationships."
Visual function in multiple personality disorder.
J Am Optom Assoc. 1996 Jun;67(6):327-34.
Birnbaum MH, Thomann K.
posted 4:35 p.m.
DID: Deconstructing DID.
Entrez PubMed: "Philadelphia Psychoanalytic Institute, PA, USA.
The author contends that a psychoanalytically informed approach to the patient with dissociative identity disorder (DID) can be very useful. However, there are difficulties in conceptualizing this condition without extending existing theory or applying in new ways what is already known. It is also difficult to put DID in a proper context relative to all the other disorders known to occur in the human mind. Depending on one's clinical experience, level of skepticism, and appreciation of history, DID may be seen as either: a) the psychological 'missing link' that realizes Freud's goal of uniting the psychology of dreams with psychopathology, or b) a fraudulent condition that is wittingly or unwittingly manufactured in the therapist's office or c) a population of disturbed and disturbing patients, once the subject of great scientific interest, which, exiled like a 'Lost Tribe,' is now back in the fold of legitimacy. The author has had extensive clinical experience with psychic trauma, and bases his own views of DID on three assumptions: 1. that dissociation may be seen as a complex defense; 2. that DID may be thought of as a 'lower level dissociative character'; and 3. that there is a unique psychic structure, the 'dissociative self' whose function is to create 'alter personalities' out of disowned affects, memories, fantasies, and drives. This 'dissociative self' must be dissolved in order for integration of 'alter personalities' to occur. A clinical vignette is offered to illustrate how he addresses some of the challenges of developing a therapeutic alliance at this end of the dissociative-character-pathology continuum, and how he grapples with the difficulty of integrating clinical phenomena, such as the appearance of 'alters"
Deconstructing DID.
Am J Psychother. 1999 Summer;53(3):344-60.
Brenner I.
The author contends that a psychoanalytically informed approach to the patient with dissociative identity disorder (DID) can be very useful. However, there are difficulties in conceptualizing this condition without extending existing theory or applying in new ways what is already known. It is also difficult to put DID in a proper context relative to all the other disorders known to occur in the human mind. Depending on one's clinical experience, level of skepticism, and appreciation of history, DID may be seen as either: a) the psychological 'missing link' that realizes Freud's goal of uniting the psychology of dreams with psychopathology, or b) a fraudulent condition that is wittingly or unwittingly manufactured in the therapist's office or c) a population of disturbed and disturbing patients, once the subject of great scientific interest, which, exiled like a 'Lost Tribe,' is now back in the fold of legitimacy. The author has had extensive clinical experience with psychic trauma, and bases his own views of DID on three assumptions: 1. that dissociation may be seen as a complex defense; 2. that DID may be thought of as a 'lower level dissociative character'; and 3. that there is a unique psychic structure, the 'dissociative self' whose function is to create 'alter personalities' out of disowned affects, memories, fantasies, and drives. This 'dissociative self' must be dissolved in order for integration of 'alter personalities' to occur. A clinical vignette is offered to illustrate how he addresses some of the challenges of developing a therapeutic alliance at this end of the dissociative-character-pathology continuum, and how he grapples with the difficulty of integrating clinical phenomena, such as the appearance of 'alters"
Deconstructing DID.
Am J Psychother. 1999 Summer;53(3):344-60.
Brenner I.
posted 4:33 p.m.
DID: Cataplexy: Cataplexy and the switch process of multiple personality disorder.
Entrez PubMed: "Institute of Psychiatry, Medical University of South Carolina, Charleston 29425-0742, USA.
La Via MC, Brewerton TD.
Cataplexy and the switch process of multiple personality disorder.
Psychiatry Res. 1996 Jul 31;63(2-3):231-2.
A case history is presented of an 18-year-old male with dissociative disorder and polysubstance abuse. The patient was observed to switch between three personalities, and the personality changes were often associated with symptoms of cataplexy. Both dissociative episodes and cataplexy are associated with strong affective stimuli. Similar reports in the literature are briefly reviewed."
La Via MC, Brewerton TD.
Cataplexy and the switch process of multiple personality disorder.
Psychiatry Res. 1996 Jul 31;63(2-3):231-2.
A case history is presented of an 18-year-old male with dissociative disorder and polysubstance abuse. The patient was observed to switch between three personalities, and the personality changes were often associated with symptoms of cataplexy. Both dissociative episodes and cataplexy are associated with strong affective stimuli. Similar reports in the literature are briefly reviewed."
posted 4:25 p.m.
DID: Headache: Transitional interpersonality thunderclap headache.
Entrez PubMed: "Department of Medicine, Franklin Medical Center, Greenfield, MA, USA.
OBJECTIVE: To report a patient with multiple personality disorder who experienced severe acute headaches without warnings, solely during the transition between her host personality and her pain-prone personality. BACKGROUND: The initial detailed description of headache in multiple personality disorder was made by Packard and Brown and published in this journal 15 years ago. METHODS: Clinical history, neurologic examination, electroencephalogram, and brain magnetic resonance imaging. RESULTS: A 54-year-old Holocaust survivor with an established diagnosis of multiple personality disorder had recurrent, excruciating, acute ('thunderclap') headaches only when switching between her domineering personality and her pain-prone personality, who suffered from chronic back pain. None of her personalities otherwise suffer from headaches. Electroencephalogram and brain magnetic resonance imaging were normal. CONCLUSION: This is an independent and current confirmation of the existence of transitional headaches in a patient with multiple personality disorder. They may occur as an isolated event during the switch process and have features of benign thunderclap headache."
Jacome DE.
Transitional interpersonality thunderclap headache.
Headache. 2001 Mar;41(3):317-20.
OBJECTIVE: To report a patient with multiple personality disorder who experienced severe acute headaches without warnings, solely during the transition between her host personality and her pain-prone personality. BACKGROUND: The initial detailed description of headache in multiple personality disorder was made by Packard and Brown and published in this journal 15 years ago. METHODS: Clinical history, neurologic examination, electroencephalogram, and brain magnetic resonance imaging. RESULTS: A 54-year-old Holocaust survivor with an established diagnosis of multiple personality disorder had recurrent, excruciating, acute ('thunderclap') headaches only when switching between her domineering personality and her pain-prone personality, who suffered from chronic back pain. None of her personalities otherwise suffer from headaches. Electroencephalogram and brain magnetic resonance imaging were normal. CONCLUSION: This is an independent and current confirmation of the existence of transitional headaches in a patient with multiple personality disorder. They may occur as an isolated event during the switch process and have features of benign thunderclap headache."
Jacome DE.
Transitional interpersonality thunderclap headache.
Headache. 2001 Mar;41(3):317-20.
posted 4:22 p.m.
Sunday, December 31, 2000
Abuse: Infant Abuse Linked To Early Experience, Not Genetics
Infant Abuse Linked To Early Experience, Not Genetics: "Intergenerational transmission of infant abuse is more likely caused by early experience than genetic inheritance, new University of Chicago research on macaque monkeys shows.
"Maternal abuse of offspring in macaque monkeys shares some similarities with child maltreatment in humans, including its transmission across generations," said Dario Maestripieri, Associate Professor in the Department of Comparative Human Development at the University of Chicago.
"The mechanisms underlying the intergenerational transmission of abuse are not well understood," said Maestripieri, who is also an affiliate scientist at the Yerkes National Primate Research Center of Emory University. " Ours is the first study to show that rhesus monkey females who are abused by their mothers in infancy tend to become abusive mothers themselves, and the first to provide experimental evidence that the intergenerational transmission of abuse is the result of early experience and not genetic inheritance," he said.
Maestripieri reports his findings in an article, "Early Experience Affects the Intergenerational Transmission of Infant Abuse in Rhesus Monkeys," published in the online Early Edition of The Proceedings of the National Academy of Sciences USA the week of June 27-July 1.
"
"Maternal abuse of offspring in macaque monkeys shares some similarities with child maltreatment in humans, including its transmission across generations," said Dario Maestripieri, Associate Professor in the Department of Comparative Human Development at the University of Chicago.
"The mechanisms underlying the intergenerational transmission of abuse are not well understood," said Maestripieri, who is also an affiliate scientist at the Yerkes National Primate Research Center of Emory University. " Ours is the first study to show that rhesus monkey females who are abused by their mothers in infancy tend to become abusive mothers themselves, and the first to provide experimental evidence that the intergenerational transmission of abuse is the result of early experience and not genetic inheritance," he said.
Maestripieri reports his findings in an article, "Early Experience Affects the Intergenerational Transmission of Infant Abuse in Rhesus Monkeys," published in the online Early Edition of The Proceedings of the National Academy of Sciences USA the week of June 27-July 1.
"
posted 11:56 p.m.
Abuse: Sexual Abuse May Affect Health For A Lifetime
Sexual Abuse May Affect Health For A Lifetime: "More than 12 percent of the women and 5 percent of the men reported early sexual abuse. On average, the first experience of abuse occurred when the women were 16 years old and the men were 13.5 years old. Most of the respondents never received counseling for their experience.
Past sexual assault was associated with an increased risk of breast cancer, arthritis and thyroid disease, Stein and Barrett-Connor found. The study results appear in the November/December issue of Psychosomatic Medicine.
The findings varied by gender. In women, early sexual assault appeared to increase the risk of arthritis and breast cancer, with multiple abuse episodes increasing disease risk by two- to three-fold compared with a single episode. In men, early sexual assault appeared to increase the risk of thyroid disease.
Although this study resembles others that found adverse health effects of sexual abuse, Stein and Barrett-Connor did not find the associations between sexual abuse and obesity or headaches observed in other studies."
Past sexual assault was associated with an increased risk of breast cancer, arthritis and thyroid disease, Stein and Barrett-Connor found. The study results appear in the November/December issue of Psychosomatic Medicine.
The findings varied by gender. In women, early sexual assault appeared to increase the risk of arthritis and breast cancer, with multiple abuse episodes increasing disease risk by two- to three-fold compared with a single episode. In men, early sexual assault appeared to increase the risk of thyroid disease.
Although this study resembles others that found adverse health effects of sexual abuse, Stein and Barrett-Connor did not find the associations between sexual abuse and obesity or headaches observed in other studies."
posted 11:50 p.m.
Abuse: Boys, Too, Suffer Long-term Consequences Of Childhood Sexual Abuse
Boys, Too, Suffer Long-term Consequences Of Childhood Sexual Abuse: "Among participants in the study of more than 17,000 California adults, 25 percent of females and 16 percent of males reported experiencing childhood sexual abuse. Moreover, say the authors, sexual abuse significantly increases the risk of developing health and social problems -- such as drug and alcohol abuse, mental illness, and marital strife -- in both men and women.
A history of suicide attempt was more than twice as likely among both male and female victims as among nonvictims. Similarly, sexually abused adults of both genders faced a 40 percent greater risk of marrying an alcoholic.
Until now, most research on the effects of child sexual abuse has focused on female survivors, and little information was available on male victims. The new study shows that being male offers little protection. 'All children are vulnerable to this form of abuse, and the burden is similar for both men and women later in life,' says lead author Shanta Dube of the U.S. Centers for Disease Control and Prevention. "
A history of suicide attempt was more than twice as likely among both male and female victims as among nonvictims. Similarly, sexually abused adults of both genders faced a 40 percent greater risk of marrying an alcoholic.
Until now, most research on the effects of child sexual abuse has focused on female survivors, and little information was available on male victims. The new study shows that being male offers little protection. 'All children are vulnerable to this form of abuse, and the burden is similar for both men and women later in life,' says lead author Shanta Dube of the U.S. Centers for Disease Control and Prevention. "
posted 11:48 p.m.
Abuse: Radiologists Play Key Role In Child Abuse Cases
Radiologists Play Key Role In Child Abuse Cases: Electronic Exhibit Outlines Signs Of Abuse: "There are a number of indications of abuse that can be seen using radiography and other imaging techniques, said Andrea Walker, DO, who, along with her mentor Vesna Kriss, MD, has put together an interactive exhibit of cases from the University of Kentucky Medical Center designed to help radiologists confidently diagnose child abuse.
A red flag should go up when a radiologist finds fractures in different stages of healing, posterior rib fractures, fractures at the very end of the long bones (which can occur when a child has been shaken) and long bone fractures in children who are not walking, said Dr. Walker. In addition, MR imaging of the brain can detect repeated hemorrhages and MR spectroscopy can detected elevated lactate levels, which are found in hypoxic (loss or reduction of oxygen) injuries."
A red flag should go up when a radiologist finds fractures in different stages of healing, posterior rib fractures, fractures at the very end of the long bones (which can occur when a child has been shaken) and long bone fractures in children who are not walking, said Dr. Walker. In addition, MR imaging of the brain can detect repeated hemorrhages and MR spectroscopy can detected elevated lactate levels, which are found in hypoxic (loss or reduction of oxygen) injuries."
posted 11:46 p.m.
Abuse: Link Between Fatal Head Injuries And Reports Of Child Abuse
Researchers Find Link Between Fatal Head Injuries And Reports Of Child Abuse: "Analysis of data on infant fatal brain injuries by researchers at Dartmouth-Hitchcock Medical Center, Lebanon, N.H., suggests that the socioeconomic status of the infant�s family may be a factor on how frequently these injuries are linked to child abuse. Researchers studied data on 1,404 infants who died in 1989-91 due to injury of the head or brain. They found that infants of more educated, married, and/or Caucasian mothers were less likely to have their injuries ascribed to child abuse, compared with infants of less educated, unmarried, and/or African-American mothers. There was also a slightly greater tendency to acribe to abuse injuries to girls and babies with normal (as opposed to low) birthweights. The study was presented at the annual meeting of the Pediatric Academic Societies in New Orleans, May 1-5. "
posted 11:44 p.m.
Abuse: Women Who Were Sexually Abused As Children More Likely To Smoke
Women Who Were Sexually Abused As Children More Likely To Smoke: "Women who were sexually abused as children are much more likely to be current smokers than women who weren't abused as children. That's a key finding of a preliminary study on possible connections between sexual abuse and smoking -- a topic that has been largely overlooked in medical research."
posted 6:53 p.m.
Abuse: Guidelines for Collecting Evidence of Sexual Assault of Children Should Be Changed, Say Researchers
Guidelines for Collecting Evidence of Sexual Assault of Children Should Be Changed, Say Researchers: "Recommendations for collecting forensic evidence of sexual abuse in young children should be adapted to reflect actual patterns of abuse in children, according to child abuse experts at The Children's Hospital of Philadelphia. More appropriate guidelines could benefit the child victims, while being more likely to yield evidence of the assault, suggest the researchers in the July issue of Pediatrics. "
posted 6:51 p.m.
Friday, December 31, 1999
Melancholic Depression: Imaging Technology May Be Used To Diagnose Melancholic Depression
Imaging Technology May Be Used To Diagnose Melancholic Depression: "In the brain, low levels of the inhibitory transmitter GABA and high levels of the excitatory neurotransmitter glutamate appear to be strongly associated with a particular type of depression, according to a study by Yale researchers."
posted 11:17 p.m.
OCD: Riluzole eases Obsessive-compulsive symptoms
Medication Eases Obsessive-compulsive Symptoms: "A medication used to ease symptoms of amyotrophic lateral sclerosis, or Lou Gehrig's disease, also is helpful in treating people with treatment-resistant obsessive-compulsive disorder (OCD), according to a pilot study at Yale School of Medicine."
posted 11:15 p.m.
Schizophrenia: Two Models Of Schizophrenia
Yale Study Reconciles Two Models Of Schizophrenia: "Yale School of Medicine researchers published a report this month in the Archives of General Psychiatry that highlights the interplay of two brain signaling systems, glutamate and dopamine, in psychosis and cognitive function.
"This study lends support to the hypothesis that drugs that facilitate the function of particular dopamine receptors might play a role in treating cognitive impairments associated with schizophrenia," Krystal said.
Co-authors include Edward Perry Jr., M.D., Ralitza Gueorguieva, Aysenil Belger, Steven Madonick, M.D., Anissa Abi-Dargham, M.D., Thomas Cooper, Lisa MacDougall, Walid Abi-Saab, M.D., and Cyril D'Souza, M.D.
Archives of General Psychiatry 62: 985-995 (September 2005)
"
"This study lends support to the hypothesis that drugs that facilitate the function of particular dopamine receptors might play a role in treating cognitive impairments associated with schizophrenia," Krystal said.
Co-authors include Edward Perry Jr., M.D., Ralitza Gueorguieva, Aysenil Belger, Steven Madonick, M.D., Anissa Abi-Dargham, M.D., Thomas Cooper, Lisa MacDougall, Walid Abi-Saab, M.D., and Cyril D'Souza, M.D.
Archives of General Psychiatry 62: 985-995 (September 2005)
"
posted 11:13 p.m.
Saturday, October 31, 1998
Bipolar: Link Suggested Between Regions On Two Chromosomes 6 & 8 and Bipolar Disorder
Link Suggested Between Regions On Two Chromosomes And Bipolar Disorder: "More than two million American adults have bipolar disorder, according to the National Institute of Mental Health. Patients typically experience dramatic mood swings from episodes of euphoria and high energy to feelings of intense sadness, fatigue, and even suicide. Psychiatrists have identified two primary forms of the illness: bipolar I disorder, which is the classic form of recurring mania and depression, and bipolar II disorder, which has less severe episodes of mania.
The resulting analysis involved 1,067 families and 5,179 individuals from North America, Italy, Germany, Portugal, the UK, Ireland, and Israel, who had provided blood samples and family medical histories. The research team combined the data into a single genome scan and found strong genetic signals on chromosomes 6 and 8. The team now hopes to narrow the search to find associations between specific genes and the mental illness.
The study will appear in the October issue of the American Journal of Human Genetics and is available now in the journal's electronic edition online at http://www.journals.uchicago.edu/AJHG/journal/contents/v77n4.html.
The original news release can be found here.
Harvard School of Public Health
Date:
2005-09-16"
The resulting analysis involved 1,067 families and 5,179 individuals from North America, Italy, Germany, Portugal, the UK, Ireland, and Israel, who had provided blood samples and family medical histories. The research team combined the data into a single genome scan and found strong genetic signals on chromosomes 6 and 8. The team now hopes to narrow the search to find associations between specific genes and the mental illness.
The study will appear in the October issue of the American Journal of Human Genetics and is available now in the journal's electronic edition online at http://www.journals.uchicago.edu/AJHG/journal/contents/v77n4.html.
The original news release can be found here.
Harvard School of Public Health
Date:
2005-09-16"
posted 6:58 p.m.
Monday, August 31, 1998
Sensorimotor Psychotherapy: One Method for Processing Traumatic Memory.
David Baldwin's Trauma Information, Articles:
Ogden & Minton (2000)
Sensorimotor Psychotherapy: One Method for Processing Traumatic Memory.
Article published in the electronic journal Traumatology, 6(3), article 3 (October 2000).
In this article, Pat Ogden and Kekuni Minton describe their somatic (body) clinical approach to facilitate processing of unassimilated sensorimotor reactions to trauma; this sensorimotor sequencing, in turn, facilitates emotional and cognitive processing. Sensorimotor Psychotherapy requires that the clinician closely monitor sequential physical movements and sensations associated with motor impulses in the client -- muscular tension, trembling, changes in breathing, posture, and heart rate. The article describes physical defensive responses, 'bottom-up' processing, and a modulation model; case examples illustrate the authors' clinical technique. "
Ogden & Minton (2000)
Sensorimotor Psychotherapy: One Method for Processing Traumatic Memory.
Article published in the electronic journal Traumatology, 6(3), article 3 (October 2000).
In this article, Pat Ogden and Kekuni Minton describe their somatic (body) clinical approach to facilitate processing of unassimilated sensorimotor reactions to trauma; this sensorimotor sequencing, in turn, facilitates emotional and cognitive processing. Sensorimotor Psychotherapy requires that the clinician closely monitor sequential physical movements and sensations associated with motor impulses in the client -- muscular tension, trembling, changes in breathing, posture, and heart rate. The article describes physical defensive responses, 'bottom-up' processing, and a modulation model; case examples illustrate the authors' clinical technique. "
posted 11:50 p.m.
Wednesday, February 28, 1990
Approaches to the Treatment of PTSD.
David Baldwin's Trauma Information, Articles:
Van der Kolk, Van der Hart & Burbridge (1995)
Approaches to the Treatment of PTSD.
Originally appeared in S. Hobfoll & M. de Vries (Eds.), Extreme stress and communities: Impact and intervention (NATO Asi Series. Series D, Behavioural and Social Sciences, Vol 80). Norwell, MA: Kluwer Academic.
This article considers PTSD as a biological disorder, and discusses the roles of developmental level, memory, and dissociation in its formation. Bessel van der Kolk and his colleagues review the symptomatology of PTSD in detail, and describe three principle components of treatment, before turning to specific tasks guiding psychotherapeutic interventions including group therapy and psychopharmacological approaches. Two Tables summarize symptoms of simple PTSD and additional features associated with the proposed diagnosis of complicated PTSD. Includes about 70 references. "
Van der Kolk, Van der Hart & Burbridge (1995)
Approaches to the Treatment of PTSD.
Originally appeared in S. Hobfoll & M. de Vries (Eds.), Extreme stress and communities: Impact and intervention (NATO Asi Series. Series D, Behavioural and Social Sciences, Vol 80). Norwell, MA: Kluwer Academic.
This article considers PTSD as a biological disorder, and discusses the roles of developmental level, memory, and dissociation in its formation. Bessel van der Kolk and his colleagues review the symptomatology of PTSD in detail, and describe three principle components of treatment, before turning to specific tasks guiding psychotherapeutic interventions including group therapy and psychopharmacological approaches. Two Tables summarize symptoms of simple PTSD and additional features associated with the proposed diagnosis of complicated PTSD. Includes about 70 references. "
posted 11:50 p.m.
Dissociation, Affect Dysregulation & Somatization: the complex nature of adaptation to trauma.
David Baldwin's Trauma Information, Articles:
Van der Kolk, Pelcovitz, Roth, Mandel, McFarlane & Herman (1996)
Dissociation, Affect Dysregulation & Somatization: the complex nature of adaptation to trauma.
This paper originally appeared in the American Journal of Psychiatry, 153(7), Festschrift Supplement, 83-93.
This article reports results from the DSM-IV Field Trial for PTSD demonstrating a complex PTSD syndrome in people traumatized at an early age, or suffering from prolonged interpersonal trauma. Dissociation, somatization, and affect dysregulation represent a chronic adaptation to emotional trauma, and characterize complex PTSD (e.g., DESNOS). Clinicians should understand how complex trauma must be treated differently from acute or 'simple' PTSD. The authors discuss implications for treatment and for PTSD diagnostic criteria. Includes four tables and about 90 references. "
Van der Kolk, Pelcovitz, Roth, Mandel, McFarlane & Herman (1996)
Dissociation, Affect Dysregulation & Somatization: the complex nature of adaptation to trauma.
This paper originally appeared in the American Journal of Psychiatry, 153(7), Festschrift Supplement, 83-93.
This article reports results from the DSM-IV Field Trial for PTSD demonstrating a complex PTSD syndrome in people traumatized at an early age, or suffering from prolonged interpersonal trauma. Dissociation, somatization, and affect dysregulation represent a chronic adaptation to emotional trauma, and characterize complex PTSD (e.g., DESNOS). Clinicians should understand how complex trauma must be treated differently from acute or 'simple' PTSD. The authors discuss implications for treatment and for PTSD diagnostic criteria. Includes four tables and about 90 references. "
posted 11:50 p.m.
Dissociation and the Fragmentary Nature of Traumatic Memories: Overview and Exploratory Study.
David Baldwin's Trauma Information, Articles:
Van der Kolk & Fisler (1995)
Dissociation and the Fragmentary Nature of Traumatic Memories: Overview and Exploratory Study.
This is a version of their article published in the Journal of Traumatic Stress, 1995, 8(4), 505-525.
In this article, Bessel van der Kolk and Rita Fisler review differences between memories of traumatic vs. stressful events and summarize evidence implicating dissociation as an important mechanism in the formation of PTSD. The authors also present results from an exploratory interview study, indicating that subjects (N=46) with PTSD initially retrieve traumatic memories as fragmentary dissociated elements (such as visual, olfactory, or affective experiences), followed by gradual emergence of a personal narrative (explicit memory). Includes 78 references"
Van der Kolk & Fisler (1995)
Dissociation and the Fragmentary Nature of Traumatic Memories: Overview and Exploratory Study.
This is a version of their article published in the Journal of Traumatic Stress, 1995, 8(4), 505-525.
In this article, Bessel van der Kolk and Rita Fisler review differences between memories of traumatic vs. stressful events and summarize evidence implicating dissociation as an important mechanism in the formation of PTSD. The authors also present results from an exploratory interview study, indicating that subjects (N=46) with PTSD initially retrieve traumatic memories as fragmentary dissociated elements (such as visual, olfactory, or affective experiences), followed by gradual emergence of a personal narrative (explicit memory). Includes 78 references"
posted 11:50 p.m.
The Body Keeps the Score: Memory and the Evolving Psychobiology of Post Traumatic Stress.
David Baldwin's Trauma Information, Articles: Van der Kolk (1994)
The Body Keeps the Score: Memory and the Evolving Psychobiology of Post Traumatic Stress.
This is a version of an article first published in the Harvard Review of Psychiatry, 1994, 1(5), 253-265.
Bessel van der Kolk reviews memory for traumatic events in this article. He discusses limbic system involvement in stress responses, psychobiological and developmental factors influencing how traumatic memories may be consolidated in the brain, and neuroendocrine abnormalities associated with PTSD. This article provides an excellent and very clear description of many aspects of memory for traumatic events, and it includes extensive references. Two tables and two figures are not available in this version. Includes 134 references. "
The Body Keeps the Score: Memory and the Evolving Psychobiology of Post Traumatic Stress.
This is a version of an article first published in the Harvard Review of Psychiatry, 1994, 1(5), 253-265.
Bessel van der Kolk reviews memory for traumatic events in this article. He discusses limbic system involvement in stress responses, psychobiological and developmental factors influencing how traumatic memories may be consolidated in the brain, and neuroendocrine abnormalities associated with PTSD. This article provides an excellent and very clear description of many aspects of memory for traumatic events, and it includes extensive references. Two tables and two figures are not available in this version. Includes 134 references. "
posted 11:50 p.m.
The Compulsion to Repeat the Trauma: Re-enactment, revictimization, and masochism.
David Baldwin's Trauma Information, Articles:
Van der Kolk (1989)
The Compulsion to Repeat the Trauma: Re-enactment, revictimization, and masochism.
This article first appeared in Psychiatric Clinics of North America, 12, (2), 389-411.
Repetition of traumatic experiences can occur on behavioral, emotional, physiologic, and neuroendocriniologic levels, but invariably causes suffering. In this 1989 article, Bessel van der Kolk describes the diversity of traumatic re-enactments, and addresses relationships to social attachment and separation, traumatic bonding, state-dependent learning, addiction to trauma, sex differences, and biological responses to trauma. Treatment implications are also discussed. 147 references. "
Van der Kolk (1989)
The Compulsion to Repeat the Trauma: Re-enactment, revictimization, and masochism.
This article first appeared in Psychiatric Clinics of North America, 12, (2), 389-411.
Repetition of traumatic experiences can occur on behavioral, emotional, physiologic, and neuroendocriniologic levels, but invariably causes suffering. In this 1989 article, Bessel van der Kolk describes the diversity of traumatic re-enactments, and addresses relationships to social attachment and separation, traumatic bonding, state-dependent learning, addiction to trauma, sex differences, and biological responses to trauma. Treatment implications are also discussed. 147 references. "
posted 11:50 p.m.
Somatoform Dissociation in Traumatized World War I Combat Soldiers: A Neglected Clinical Heritage.
David Baldwin's Trauma Information, Articles:
Van der Hart, et al (2000)
Somatoform Dissociation in Traumatized World War I Combat Soldiers: A Neglected Clinical Heritage.
Originally published in the Journal of Trauma and Dissociation, 2000, 1(4), 33-66. [Reprinted here with permission of the author, Editors of the Journal of Trauma and Dissociation, and Haworth Press.]
Onno van der Hart and colleagues explore traumatic dissociation from descriptive, structural and functional perspectives. This article deepens our understanding of dissociation -- including perceptual, sensory, and motoric (somatoform) symptoms along with the cognitive (psychoform) symptoms in the DSM. Quotes from early writers dramatically illustrate various positive and negative dissociative symptoms in WWI combat soldiers. The authors emphasize the dissociative nature of somatoform symptoms seen in contemporary PTSD patients, and relate early observations by Charles S. Myers and by Pierre Janet to recent work by Ellert Nijenhuis and others. 111 references."
Van der Hart, et al (2000)
Somatoform Dissociation in Traumatized World War I Combat Soldiers: A Neglected Clinical Heritage.
Originally published in the Journal of Trauma and Dissociation, 2000, 1(4), 33-66. [Reprinted here with permission of the author, Editors of the Journal of Trauma and Dissociation, and Haworth Press.]
Onno van der Hart and colleagues explore traumatic dissociation from descriptive, structural and functional perspectives. This article deepens our understanding of dissociation -- including perceptual, sensory, and motoric (somatoform) symptoms along with the cognitive (psychoform) symptoms in the DSM. Quotes from early writers dramatically illustrate various positive and negative dissociative symptoms in WWI combat soldiers. The authors emphasize the dissociative nature of somatoform symptoms seen in contemporary PTSD patients, and relate early observations by Charles S. Myers and by Pierre Janet to recent work by Ellert Nijenhuis and others. 111 references."
posted 11:50 p.m.
Time Distortions in Dissociative Identity Disorder: Janetian Concepts and Treatment.
David Baldwin's Trauma Information, Articles:
Van der Hart & Steele (1997)
Time Distortions in Dissociative Identity Disorder: Janetian Concepts and Treatment.
Originally published in Dissociation, 1997, 10(2), 91-103. [Posted here with permission of the authors and Journal Editor.]
Disturbances in a sense of reality and time are especially dramatic in trauma-induced disorders, including dissociative identity disorder (DID). Observing that therapeutic change involves reorganizing the patient's experience of reality and time, Onno van der Hart and Kathy Steele describe therapeutic approaches that can assist this reorganization, within their phase-oriented treatment model. They integrate Pierre Janet's contributions regarding time disturbances with more contemporary work relating time disturbances to trauma, and offer case examples. 52 references. "
Van der Hart & Steele (1997)
Time Distortions in Dissociative Identity Disorder: Janetian Concepts and Treatment.
Originally published in Dissociation, 1997, 10(2), 91-103. [Posted here with permission of the authors and Journal Editor.]
Disturbances in a sense of reality and time are especially dramatic in trauma-induced disorders, including dissociative identity disorder (DID). Observing that therapeutic change involves reorganizing the patient's experience of reality and time, Onno van der Hart and Kathy Steele describe therapeutic approaches that can assist this reorganization, within their phase-oriented treatment model. They integrate Pierre Janet's contributions regarding time disturbances with more contemporary work relating time disturbances to trauma, and offer case examples. 52 references. "
posted 11:50 p.m.
The Treatment of Traumatic Memories: synthesis, realization, and integration.
David Baldwin's Trauma Information, Articles:
Van der Hart, et al (1993)
The Treatment of Traumatic Memories: synthesis, realization, and integration.
Originally published in Dissociation,1993, 6(2/3), 162-180. [Posted here with permission of the authors and Journal Editor.]
Onno van der Hart and colleagues integrate Pierre Janet's dissociation theory with contemporary trauma-based models of therapy. They begin by describing multiple personality disorder (now DID) as a disorder of non-realization, and then explore the nature of traumatic memories and the dissociative reactions they evoke, before presenting a phase-oriented treatment model for trauma-focused therapy with dissociative patients. Their non-abreactive treatment approach is appropriate for resolution of traumatic memories in adult survivors of chronic childhood abuse. 118 references. "
Van der Hart, et al (1993)
The Treatment of Traumatic Memories: synthesis, realization, and integration.
Originally published in Dissociation,1993, 6(2/3), 162-180. [Posted here with permission of the authors and Journal Editor.]
Onno van der Hart and colleagues integrate Pierre Janet's dissociation theory with contemporary trauma-based models of therapy. They begin by describing multiple personality disorder (now DID) as a disorder of non-realization, and then explore the nature of traumatic memories and the dissociative reactions they evoke, before presenting a phase-oriented treatment model for trauma-focused therapy with dissociative patients. Their non-abreactive treatment approach is appropriate for resolution of traumatic memories in adult survivors of chronic childhood abuse. 118 references. "
posted 11:50 p.m.
Abreaction Re-evaluated.
David Baldwin's Trauma Information, Articles:
Van der Hart & Brown (1992)
Abreaction Re-evaluated.
Originally published in Dissociation,1992, 6(2/3), 162-180. [Posted here with permission of the authors and Journal Editor.]
Onno van der Hart and Paul Brown review the use of 'abreaction' in treating traumatic memories from Breuer and Freud through World Wars I and II, Vietnam, and in contemporary times. After tracing the historical and theoretical roots of two contradictory models concerning the nature and treatment of traumatic memories (dissociation/integration and abreaction/repression), the authors critically re-evaluate abreaction, and conclude that Janet's model of dissociation provides a preferable basis for phase-oriented treatment of the more complex traumatic-stress disorders. 103 references. "
Van der Hart & Brown (1992)
Abreaction Re-evaluated.
Originally published in Dissociation,1992, 6(2/3), 162-180. [Posted here with permission of the authors and Journal Editor.]
Onno van der Hart and Paul Brown review the use of 'abreaction' in treating traumatic memories from Breuer and Freud through World Wars I and II, Vietnam, and in contemporary times. After tracing the historical and theoretical roots of two contradictory models concerning the nature and treatment of traumatic memories (dissociation/integration and abreaction/repression), the authors critically re-evaluate abreaction, and conclude that Janet's model of dissociation provides a preferable basis for phase-oriented treatment of the more complex traumatic-stress disorders. 103 references. "
posted 11:50 p.m.
A Reader’s Guide To Pierre Janet: A Neglected Intellectual Heritage.
David Baldwin's Trauma Information, Articles:
Van der Hart & Friedman (1989)
A Reader’s Guide To Pierre Janet: A Neglected Intellectual Heritage.
Originally published in Dissociation,1989, 2(1), 3-16. [Posted here with permission of the authors and Journal Editor.]
Onno van der Hart and Barbara Friedman review Pierre Janet's writings on hysteria and dissociation over a 30-year period, summarizing their central concepts. Janet was an important figure in early studies on dissociation and hysteria before hypnosis fell into disrepute, but his writings, many in French, are not well known in the US. Seven books are reviewed here; they focus primarily on classification and case descriptions. 94 references. "
Van der Hart & Friedman (1989)
A Reader’s Guide To Pierre Janet: A Neglected Intellectual Heritage.
Originally published in Dissociation,1989, 2(1), 3-16. [Posted here with permission of the authors and Journal Editor.]
Onno van der Hart and Barbara Friedman review Pierre Janet's writings on hysteria and dissociation over a 30-year period, summarizing their central concepts. Janet was an important figure in early studies on dissociation and hysteria before hypnosis fell into disrepute, but his writings, many in French, are not well known in the US. Seven books are reviewed here; they focus primarily on classification and case descriptions. 94 references. "
posted 11:50 p.m.
Introduction to Survival Strategies.
David Baldwin's Trauma Information, Articles:
Valent (1998)
Introduction to Survival Strategies.
This is a version of an important chapter from Valent's 1998 book, From Survival to Fulfillment: A framework for the life-trauma dialectic, published in Philadelphia by Bruner/Mazel.
Paul Valent describes eight survival strategies in response to trauma -- 'stress responses which include specific adaptive and maladaptive, biological, psychological and social constituents'. Valent's survival strategies evolved as discrete phylogenetic templates to aid survival following specific stressors. Together, survival strategies offer a framework for categorizing classes of traumatic responses and events beyond PTSD's typical fight or flight responses. When trauma responses are unsuccessful, this framework may also help clarify differences important in treatment. "
Valent (1998)
Introduction to Survival Strategies.
This is a version of an important chapter from Valent's 1998 book, From Survival to Fulfillment: A framework for the life-trauma dialectic, published in Philadelphia by Bruner/Mazel.
Paul Valent describes eight survival strategies in response to trauma -- 'stress responses which include specific adaptive and maladaptive, biological, psychological and social constituents'. Valent's survival strategies evolved as discrete phylogenetic templates to aid survival following specific stressors. Together, survival strategies offer a framework for categorizing classes of traumatic responses and events beyond PTSD's typical fight or flight responses. When trauma responses are unsuccessful, this framework may also help clarify differences important in treatment. "
posted 11:50 p.m.
Dependency in the Treatment of Complex Posttraumatic Stress Disorder and Dissociative Disorders.
David Baldwin's Trauma Information, Articles:
Steele, Van der Hart & Nijenhuis (2001)
Dependency in the Treatment of Complex Posttraumatic Stress Disorder and Dissociative Disorders.
Originally published in: Journal of Trauma and Dissociation, 2(4), 79-116.
Kathy Steele and colleagues address the issue of dependency in chronically traumatized patients -- individuals often diagnosed with Bipolar Personality, Complex PTSD, or Dissociative Disorders. They first discuss the concept of dependency, exploring its origins in attachment difficulties and questioning prevailing beliefs before describing its relationship to structural dissociation and countertransference in psychotherapy. Then, using the theory of structural dissociation, the authors offer practical strategies to help clinicians manage insecure dependency within the therapy context. 129 references. "
Steele, Van der Hart & Nijenhuis (2001)
Dependency in the Treatment of Complex Posttraumatic Stress Disorder and Dissociative Disorders.
Originally published in: Journal of Trauma and Dissociation, 2(4), 79-116.
Kathy Steele and colleagues address the issue of dependency in chronically traumatized patients -- individuals often diagnosed with Bipolar Personality, Complex PTSD, or Dissociative Disorders. They first discuss the concept of dependency, exploring its origins in attachment difficulties and questioning prevailing beliefs before describing its relationship to structural dissociation and countertransference in psychotherapy. Then, using the theory of structural dissociation, the authors offer practical strategies to help clinicians manage insecure dependency within the therapy context. 129 references. "
posted 11:50 p.m.
Can the Different Cerebral Hemispheres Have Distinct Personalities? Evidence and Its Implications for Theory and Treatment of PTSD and Other Disorders
David Baldwin's Trauma Information, Articles:
Schiffer (2000)
Can the Different Cerebral Hemispheres Have Distinct Personalities? Evidence and Its Implications for Theory and Treatment of PTSD and Other Disorders.
(This site author's note: It is clinically evident that the cerebral hemispheres do contain separate identities, though the right hemisphere is involved in the processing of unpleasant memories.
Originally published in the Journal of Trauma and Dissociation, 1, 83-104.
Fredric Schiffer, M.D., reviews literature and hypothesizes that psychological traumas are associated more with one cerebral hemisphere than the other, and concludes that the ultimate aim of psychiatric care then becomes the teaching of the mental entity associated with this troubled hemisphere that it is now safer and more valued than it had been at the time of the trauma. He summarizes anecdotal evidence indicating that lateralized sensory stimulation can be used as an effective adjunct to psychotherapy, and describes the practical application of this theory to psychotherapy. "
Schiffer (2000)
Can the Different Cerebral Hemispheres Have Distinct Personalities? Evidence and Its Implications for Theory and Treatment of PTSD and Other Disorders.
(This site author's note: It is clinically evident that the cerebral hemispheres do contain separate identities, though the right hemisphere is involved in the processing of unpleasant memories.
Originally published in the Journal of Trauma and Dissociation, 1, 83-104.
Fredric Schiffer, M.D., reviews literature and hypothesizes that psychological traumas are associated more with one cerebral hemisphere than the other, and concludes that the ultimate aim of psychiatric care then becomes the teaching of the mental entity associated with this troubled hemisphere that it is now safer and more valued than it had been at the time of the trauma. He summarizes anecdotal evidence indicating that lateralized sensory stimulation can be used as an effective adjunct to psychotherapy, and describes the practical application of this theory to psychotherapy. "
posted 11:50 p.m.
Dysregulation of the Right Brain: A Fundamental Mechanism of Traumatic Attachment and the Psychopathogenesis of Posttraumatic Stress Disorder.
David Baldwin's Trauma Information, Articles:
Schore (2002)
Dysregulation of the Right Brain: A Fundamental Mechanism of Traumatic Attachment and the Psychopathogenesis of Posttraumatic Stress Disorder.
Published in Australian and New Zealand Journal of Psychiatry, 36, 9-30.
In a review article written specifically for clinical and research traumatologists, Allan Schore sketches developmental precursors of complex PTSD and dissociative symptoms in the effects of early relational trauma on the developing central and autonomic nervous system. Early traumatic attachments negatively impact right brain development, producing structural changes that lead to inefficent stress coping mechanisms -- the core of posttraumatic stress disorders in infants, children, and adults. Schore makes a strong case that early intervention prevention programs can reduce intergenerational transmission of trauma-related disorders across the lifespan. 246 references. "
Schore (2002)
Dysregulation of the Right Brain: A Fundamental Mechanism of Traumatic Attachment and the Psychopathogenesis of Posttraumatic Stress Disorder.
Published in Australian and New Zealand Journal of Psychiatry, 36, 9-30.
In a review article written specifically for clinical and research traumatologists, Allan Schore sketches developmental precursors of complex PTSD and dissociative symptoms in the effects of early relational trauma on the developing central and autonomic nervous system. Early traumatic attachments negatively impact right brain development, producing structural changes that lead to inefficent stress coping mechanisms -- the core of posttraumatic stress disorders in infants, children, and adults. Schore makes a strong case that early intervention prevention programs can reduce intergenerational transmission of trauma-related disorders across the lifespan. 246 references. "
posted 11:50 p.m.
The Effects of Early Relational Trauma on Right Brain Development, Affect Regulation, and Infant Mental Health.
David Baldwin's Trauma Information, Articles:
Schore (2001 b)
The Effects of Early Relational Trauma on Right Brain Development, Affect Regulation, and Infant Mental Health.
Published in Infant Journal of Mental Health, 2001, 22, 201-269.
In the second part of his two-part interdisciplinary review, Allan Schore focuses on severe attachment failures, impairments in early development of the right brain's stress coping systems, and maladaptive infant mental health -- suggesting direct connections between traumatic attachment, inefficient right brain regulatory functions, and both maladaptive infant and adult mental health. He describes the neurobiology of infant trauma, neuropsychology of a disorganized / disoriented attachment pattern (associated with abuse and neglect), trauma-induced impairments of a regulatory system in the orbitofrontal cortex, links between orbitofrontal dysfunction and a predisposition to posttraumatic stress disorders, neurobiology of the dissociative defense, effects of early relational trauma on enduring right hemispheric function, and offers some implications for early intervention. 450 references. "
Schore (2001 b)
The Effects of Early Relational Trauma on Right Brain Development, Affect Regulation, and Infant Mental Health.
Published in Infant Journal of Mental Health, 2001, 22, 201-269.
In the second part of his two-part interdisciplinary review, Allan Schore focuses on severe attachment failures, impairments in early development of the right brain's stress coping systems, and maladaptive infant mental health -- suggesting direct connections between traumatic attachment, inefficient right brain regulatory functions, and both maladaptive infant and adult mental health. He describes the neurobiology of infant trauma, neuropsychology of a disorganized / disoriented attachment pattern (associated with abuse and neglect), trauma-induced impairments of a regulatory system in the orbitofrontal cortex, links between orbitofrontal dysfunction and a predisposition to posttraumatic stress disorders, neurobiology of the dissociative defense, effects of early relational trauma on enduring right hemispheric function, and offers some implications for early intervention. 450 references. "
posted 11:50 p.m.
The Effects of a Secure Attachment Relationship on Right Brain Development, Affect Regulation, and Infant Mental Health.
David Baldwin's Trauma Information, Articles:
Schore (2001 a)
The Effects of a Secure Attachment Relationship on Right Brain Development, Affect Regulation, and Infant Mental Health.
Published in Infant Journal of Mental Health, 2001, 22, 7-66.
In the first part of a two-part review, Allan Schore reviews psychoneurobiological mechanisms underlying infant mental health and successful adaptation. He integrates attachment data on dyadic affective communications, developmental neuroscience research on the right brain and stress psychophysiology, and developmental psychopathology perspectives on psychopathogenesis. This provides an overview of healthy development: connecting attachment theory, stress regulation, and infant mental health. Schore also describes the neurobiology of a secure attachment, and development of the right brain, early limbic system, and orbital frontolimbic regions, suggesting that normal orbitofrontal and right brain development is connected to adaptive mental health. 379 references. "
Schore (2001 a)
The Effects of a Secure Attachment Relationship on Right Brain Development, Affect Regulation, and Infant Mental Health.
Published in Infant Journal of Mental Health, 2001, 22, 7-66.
In the first part of a two-part review, Allan Schore reviews psychoneurobiological mechanisms underlying infant mental health and successful adaptation. He integrates attachment data on dyadic affective communications, developmental neuroscience research on the right brain and stress psychophysiology, and developmental psychopathology perspectives on psychopathogenesis. This provides an overview of healthy development: connecting attachment theory, stress regulation, and infant mental health. Schore also describes the neurobiology of a secure attachment, and development of the right brain, early limbic system, and orbital frontolimbic regions, suggesting that normal orbitofrontal and right brain development is connected to adaptive mental health. 379 references. "
posted 11:50 p.m.
The Effects of Early Relational Trauma on Right Brain Development, Affect Regulation, and Infant Mental Health.
David Baldwin's Trauma Information, Articles:
Schore (2001 b)
The Effects of Early Relational Trauma on Right Brain Development, Affect Regulation, and Infant Mental Health.
Published in Infant Journal of Mental Health, 2001, 22, 201-269.
In the second part of his two-part interdisciplinary review, Allan Schore focuses on severe attachment failures, impairments in early development of the right brain's stress coping systems, and maladaptive infant mental health -- suggesting direct connections between traumatic attachment, inefficient right brain regulatory functions, and both maladaptive infant and adult mental health. He describes the neurobiology of infant trauma, neuropsychology of a disorganized / disoriented attachment pattern (associated with abuse and neglect), trauma-induced impairments of a regulatory system in the orbitofrontal cortex, links between orbitofrontal dysfunction and a predisposition to posttraumatic stress disorders, neurobiology of the dissociative defense, effects of early relational trauma on enduring right hemispheric function, and offers some implications for early intervention. 450 references. "
Schore (2001 b)
The Effects of Early Relational Trauma on Right Brain Development, Affect Regulation, and Infant Mental Health.
Published in Infant Journal of Mental Health, 2001, 22, 201-269.
In the second part of his two-part interdisciplinary review, Allan Schore focuses on severe attachment failures, impairments in early development of the right brain's stress coping systems, and maladaptive infant mental health -- suggesting direct connections between traumatic attachment, inefficient right brain regulatory functions, and both maladaptive infant and adult mental health. He describes the neurobiology of infant trauma, neuropsychology of a disorganized / disoriented attachment pattern (associated with abuse and neglect), trauma-induced impairments of a regulatory system in the orbitofrontal cortex, links between orbitofrontal dysfunction and a predisposition to posttraumatic stress disorders, neurobiology of the dissociative defense, effects of early relational trauma on enduring right hemispheric function, and offers some implications for early intervention. 450 references. "
posted 11:50 p.m.
The Neurophysiology of Dissociation and Chronic Disease.
David Baldwin's Trauma Information, Articles:
Scaer (2001)
The Neurophysiology of Dissociation and Chronic Disease.
Published in Applied Psychophysiology and Biofeedback, 2001, 26(1), 73-91.
Dr. Robert Scaer examines dissociation and PTSD from the perspective of a neurologist. In this speculative article, he describes dissociation in terms of the freeze/immobility response observed in animals facing overwhelming threat. He also proposes a model of PTSD linked to autonomic dysregulation -- and maintained by kindling, dorsal vagal tone and endorphinergic rewards -- contributing to further dissociation. Finally, the autonomic dysregulation underlying dissociation and PTSD is discussed in the context of a diverse set of chronic diseases of unknown origin. 74 references. "
Scaer (2001)
The Neurophysiology of Dissociation and Chronic Disease.
Published in Applied Psychophysiology and Biofeedback, 2001, 26(1), 73-91.
Dr. Robert Scaer examines dissociation and PTSD from the perspective of a neurologist. In this speculative article, he describes dissociation in terms of the freeze/immobility response observed in animals facing overwhelming threat. He also proposes a model of PTSD linked to autonomic dysregulation -- and maintained by kindling, dorsal vagal tone and endorphinergic rewards -- contributing to further dissociation. Finally, the autonomic dysregulation underlying dissociation and PTSD is discussed in the context of a diverse set of chronic diseases of unknown origin. 74 references. "
posted 11:50 p.m.
Instinct and the Unconscious: a contribution to a biological theory of the psycho-neuroses.
Rivers (1920)
Instinct and the Unconscious: a contribution to a biological theory of the psycho-neuroses.
Full text of the book, originally published in 1920 by Cambridge University Press in England, courtesy of Christopher Green's Classics in the History of Psychology website.
In this book, Dr. Rivers explores theoretical aspects of his clinical experiences, at Maghull and Craiglockhart War Hospitals, treating "shell shock" and "war neuroses" among soldiers traumatized in WWI combat. His insight that avoidance of traumatic experiences does not assist recovery was prescient, and he saw dissociation as one type of suppression -- thus distinguishing distinct avoidance strategies. Rivers discusses self-preservation and "danger instincts" stirred during trauma in conjunction with Freud's ideas about the unconscious; this placed psychotherapy, especially for the traumatic form of "psycho-neuroses", within the theoretical framework of biology.
Instinct and the Unconscious: a contribution to a biological theory of the psycho-neuroses.
Full text of the book, originally published in 1920 by Cambridge University Press in England, courtesy of Christopher Green's Classics in the History of Psychology website.
In this book, Dr. Rivers explores theoretical aspects of his clinical experiences, at Maghull and Craiglockhart War Hospitals, treating "shell shock" and "war neuroses" among soldiers traumatized in WWI combat. His insight that avoidance of traumatic experiences does not assist recovery was prescient, and he saw dissociation as one type of suppression -- thus distinguishing distinct avoidance strategies. Rivers discusses self-preservation and "danger instincts" stirred during trauma in conjunction with Freud's ideas about the unconscious; this placed psychotherapy, especially for the traumatic form of "psycho-neuroses", within the theoretical framework of biology.
posted 11:50 p.m.
An Address on the Repression of War Experience.
David Baldwin's Trauma Information, Articles:
Rivers (1918)
An Address on the Repression of War Experience.
Originally published in the Lancet, 1918, 1, 173-177 (2 February 1918).
In this classic article, W. H. R. Rivers writes about suppression and dissociation of traumatic combat experiences by World War I veterans, and his clinical observations that avoidance of traumatic memories -- the recommended treatment of the time -- interfered with recovery from 'shell shock' or 'war neurosis'. This historical article is significant in the development of our scientific and clinical views about trauma responses and effective treatment. Dr. Rivers views on the effective treatment of what we now call PTSD were far ahead of his time, and issues addressed in this 1918 article remain controversial today. "
Rivers (1918)
An Address on the Repression of War Experience.
Originally published in the Lancet, 1918, 1, 173-177 (2 February 1918).
In this classic article, W. H. R. Rivers writes about suppression and dissociation of traumatic combat experiences by World War I veterans, and his clinical observations that avoidance of traumatic memories -- the recommended treatment of the time -- interfered with recovery from 'shell shock' or 'war neurosis'. This historical article is significant in the development of our scientific and clinical views about trauma responses and effective treatment. Dr. Rivers views on the effective treatment of what we now call PTSD were far ahead of his time, and issues addressed in this 1918 article remain controversial today. "
posted 11:50 p.m.
Childhood Trauma, the Neurobiology of Adaptation, and Use-dependent Development of the Brain: How States become Traits.
David Baldwin's Trauma Information, Articles:
Perry, et al (1995)
Childhood Trauma, the Neurobiology of Adaptation, and Use-dependent Development of the Brain: How States become Traits.
Article published in Infant Mental Health Journal, 16(4), 271-291.
Bruce Perry and his colleagues argue that infants and young children may be more vulnerable to traumas than adults -- that they are not resilient, but malleable. They consider neurobiological consequences of repeated dissociative or hyperarousal responses on developing brain organization, and conclude that the more plastic developing brain may be more vulnerable to disruptions related to these responses. Evolutionary advantages of gender differences in responses to trauma (hyperarousal by males; dissociation in females) are considered briefly, and clinical implications are discussed. Includes about 70 references. "
Perry, et al (1995)
Childhood Trauma, the Neurobiology of Adaptation, and Use-dependent Development of the Brain: How States become Traits.
Article published in Infant Mental Health Journal, 16(4), 271-291.
Bruce Perry and his colleagues argue that infants and young children may be more vulnerable to traumas than adults -- that they are not resilient, but malleable. They consider neurobiological consequences of repeated dissociative or hyperarousal responses on developing brain organization, and conclude that the more plastic developing brain may be more vulnerable to disruptions related to these responses. Evolutionary advantages of gender differences in responses to trauma (hyperarousal by males; dissociation in females) are considered briefly, and clinical implications are discussed. Includes about 70 references. "
posted 11:50 p.m.
Violence and Childhood: How Persisting Fear Can Alter the Developing Child’s Brain.
David Baldwin's Trauma Information, Articles:
Perry (2001)
Violence and Childhood: How Persisting Fear Can Alter the Developing Child’s Brain.
Citation: Perry, B.D. (2001b). The neurodevelopmental impact of violence in childhood. In Schetky D & Benedek, E. (Eds.) Textbook of child andadolescent forensic psychiatry. Washington, D.C.: American Psychiatric Press, Inc. (pp. 221-238).
This is an edited (web) version of the chapter from the author's ChildTrauma Academy website.
Bruce Perry discusses five neural systems involved in regulating a child's response to threat: the Reticular Activating System, Locus Coeruleus, Hippocampus, Amygdala, and Hypothalamic-Pituitary-Adrenal Axis, and then describes the clinical presentation and altered neurobiology of children exposed to violence. Heartrate data and gender differences are presented from children at the Branch Davidian' s Ranch Apocalypse compound. Includes about 70 references, 3 figures and 2 tables. "
Perry (2001)
Violence and Childhood: How Persisting Fear Can Alter the Developing Child’s Brain.
Citation: Perry, B.D. (2001b). The neurodevelopmental impact of violence in childhood. In Schetky D & Benedek, E. (Eds.) Textbook of child andadolescent forensic psychiatry. Washington, D.C.: American Psychiatric Press, Inc. (pp. 221-238).
This is an edited (web) version of the chapter from the author's ChildTrauma Academy website.
Bruce Perry discusses five neural systems involved in regulating a child's response to threat: the Reticular Activating System, Locus Coeruleus, Hippocampus, Amygdala, and Hypothalamic-Pituitary-Adrenal Axis, and then describes the clinical presentation and altered neurobiology of children exposed to violence. Heartrate data and gender differences are presented from children at the Branch Davidian' s Ranch Apocalypse compound. Includes about 70 references, 3 figures and 2 tables. "
posted 11:50 p.m.
Memories of Fear.
David Baldwin's Trauma Information, Articles:
Perry (1999)
Memories of Fear.
Web version of a chapter published as 'The Memories of States' in J. Goodwin & R. Attias (Eds.) (1999). Splintered Reflections: images of the body in trauma. New York: Basic Books, pp. 9-38.
In this chapter, Dr. Perry explores how the brain 'stores and retrieves physiologic states, feelings, behaviors and thoughts from traumatic events', and illustrates these issues with several case examples of traumatized children and adolescents. Concluding sections focus on vulnerable children and the law, and on transgenerational memory in society and culture. Four figures and 59 references are included in this online version."
Perry (1999)
Memories of Fear.
Web version of a chapter published as 'The Memories of States' in J. Goodwin & R. Attias (Eds.) (1999). Splintered Reflections: images of the body in trauma. New York: Basic Books, pp. 9-38.
In this chapter, Dr. Perry explores how the brain 'stores and retrieves physiologic states, feelings, behaviors and thoughts from traumatic events', and illustrates these issues with several case examples of traumatized children and adolescents. Concluding sections focus on vulnerable children and the law, and on transgenerational memory in society and culture. Four figures and 59 references are included in this online version."
posted 11:50 p.m.
Incubated in Terror, Neurodevelopmental Factors in the Cycle of Violence.
David Baldwin's Trauma Information, Articles:
Perry (1997a)
Incubated in Terror, Neurodevelopmental Factors in the Cycle of Violence.
Citation: Perry, BD (1997). Incubated in Terror: Neurodevelopmental Factors in the 'Cycle of Violence' In: Children, Youth and Violence: The Search for Solutions (J Osofsky, Ed.). Guilford Press, New York, pp 124-148.
Bruce Perry, taking an evolutionary and developmental perspective, writes about the consequences for children exposed to violence and persistent fear. Effects on brain organization, cognitive and emotional neglect are described, and both clinical and public policy implications are considered. Includes about 80 references and 9 figures."
Perry (1997a)
Incubated in Terror, Neurodevelopmental Factors in the Cycle of Violence.
Citation: Perry, BD (1997). Incubated in Terror: Neurodevelopmental Factors in the 'Cycle of Violence' In: Children, Youth and Violence: The Search for Solutions (J Osofsky, Ed.). Guilford Press, New York, pp 124-148.
Bruce Perry, taking an evolutionary and developmental perspective, writes about the consequences for children exposed to violence and persistent fear. Effects on brain organization, cognitive and emotional neglect are described, and both clinical and public policy implications are considered. Includes about 80 references and 9 figures."
posted 11:50 p.m.
Post-traumatic Therapy.
David Baldwin's Trauma Information, Articles:
Ochberg (1991)
Post-traumatic Therapy.
Originally appeared in Psychotherapy, 28 (1), 5-15. [Spring 1991] Republished first in Wilson & Raphael's (1993) International Handbook of Traumatic Stress Syndromes and later in Everly & Lating's (1995) Psychotraumatology.
This clinical article gives a detailed description of Frank Ochberg's approach towards therapy with trauma patients, and should be helpful to any clinicians working with this population. Individual sections discuss fundamental principles and techniques of posttraumatic therapy, including: education, discussing psychobiology, promoting holistic health, and psychotherapy. Two Appendices list proposed diagnostic criteria and symptoms for victimization disorder as a subcategory of traumatic stress. "
Ochberg (1991)
Post-traumatic Therapy.
Originally appeared in Psychotherapy, 28 (1), 5-15. [Spring 1991] Republished first in Wilson & Raphael's (1993) International Handbook of Traumatic Stress Syndromes and later in Everly & Lating's (1995) Psychotraumatology.
This clinical article gives a detailed description of Frank Ochberg's approach towards therapy with trauma patients, and should be helpful to any clinicians working with this population. Individual sections discuss fundamental principles and techniques of posttraumatic therapy, including: education, discussing psychobiology, promoting holistic health, and psychotherapy. Two Appendices list proposed diagnostic criteria and symptoms for victimization disorder as a subcategory of traumatic stress. "
posted 11:50 p.m.
Trauma-related Structural Dissociation of the Personality.
David Baldwin's Trauma Information, Articles:
Nijenhuis, Van der Hart, & Steele (2004)
Trauma-related Structural Dissociation of the Personality.
Citation: Nijenhuis, E.R.S.; Van der Hart, O. & Steele, K. (2004). Trauma-related structural dissociation of the personality.
Trauma Information Pages website, January 2004. Web URL: http://www.trauma-pages.com/nijenhuis-2004.htm .
[This article is published here for the first time. Copyright by Ellert R. S. Nijenhuis; posted at www.trauma-pages.com with permission.]
Ellert Nijenhuis, writing with colleagues Onno van der Hart and Kathy Steele, presents the most detailed explanation of their theory of structural dissociation as a response to traumatization. Describing dissociation as a failure to synthesize and personify terrifying experiences, this article explores the evolutionary and trauma-related origins of this response, addresses the increasing complexity of structural dissociation into secondary and tertiary forms that may occur in cases of chronic abuse and neglect, and summarizes recent psychobiological research concerning the theory. This provides a detailed theoretical rationale for the authors' phase-oriented treatment approach. 159 references. "
Nijenhuis, Van der Hart, & Steele (2004)
Trauma-related Structural Dissociation of the Personality.
Citation: Nijenhuis, E.R.S.; Van der Hart, O. & Steele, K. (2004). Trauma-related structural dissociation of the personality.
Trauma Information Pages website, January 2004. Web URL: http://www.trauma-pages.com/nijenhuis-2004.htm .
[This article is published here for the first time. Copyright by Ellert R. S. Nijenhuis; posted at www.trauma-pages.com with permission.]
Ellert Nijenhuis, writing with colleagues Onno van der Hart and Kathy Steele, presents the most detailed explanation of their theory of structural dissociation as a response to traumatization. Describing dissociation as a failure to synthesize and personify terrifying experiences, this article explores the evolutionary and trauma-related origins of this response, addresses the increasing complexity of structural dissociation into secondary and tertiary forms that may occur in cases of chronic abuse and neglect, and summarizes recent psychobiological research concerning the theory. This provides a detailed theoretical rationale for the authors' phase-oriented treatment approach. 159 references. "
posted 11:50 p.m.
The Etiology of Combat-related Post-Traumatic Stress Disorders.
David Baldwin's Trauma Information, Articles:
Goodwin (1987)
The Etiology of Combat-related Post-Traumatic Stress Disorders.
Originally appeared as a chapter in T. Williams (Ed.) Post-Traumatic Stress Disorders: a handbook for clinicians, pp. 1-18. Cincinatti, OH: Disabled American Veterans.
This version is a detailed summary of the published chapter, available on the internet for several years. Jim Goodwin gives a clear and well-written look at the long-term consequences of combat-stress for Vietnam veterans, and similarities and differences from other kinds of traumatic-stress reactions. Individual sections describe several PTSD symptoms particularly common within this population: depression, isolation, rage, alienation, survivor guilt, anxiety, nightmares, and intrusive thoughts. "
Goodwin (1987)
The Etiology of Combat-related Post-Traumatic Stress Disorders.
Originally appeared as a chapter in T. Williams (Ed.) Post-Traumatic Stress Disorders: a handbook for clinicians, pp. 1-18. Cincinatti, OH: Disabled American Veterans.
This version is a detailed summary of the published chapter, available on the internet for several years. Jim Goodwin gives a clear and well-written look at the long-term consequences of combat-stress for Vietnam veterans, and similarities and differences from other kinds of traumatic-stress reactions. Individual sections describe several PTSD symptoms particularly common within this population: depression, isolation, rage, alienation, survivor guilt, anxiety, nightmares, and intrusive thoughts. "
posted 11:50 p.m.
Smaller Hippocampal Volume Predicts Pathologic Vulnerability to Psychological Trauma.
David Baldwin's Trauma Information, Articles:
Gilbertson, Shenton, Ciszewski, Kasai, Lasko, Orr & Pitman (2002)
Smaller Hippocampal Volume Predicts Pathologic Vulnerability to Psychological Trauma.
Originally published in: Nature Neuroscience, 2002, 5(11), 1242-1247.
In this case control study of monozygotic twins discordant for trauma exposure, Mark Gilbertson and six colleagues investigate important questions about size of hippocampus and vulnerability to trauma. The authors found that severe PTSD twin pairs -- both trauma-exposed and unexposed -- had significantly smaller hippocampi. Their results indicate that pre-existing hippocampal volume constitutes an independent risk factor for development of trauma-related psychopathology, and show one way that individual differences in vulnerability for PTSD (given a traumatic exposure) may appear. About 50 references. "
Gilbertson, Shenton, Ciszewski, Kasai, Lasko, Orr & Pitman (2002)
Smaller Hippocampal Volume Predicts Pathologic Vulnerability to Psychological Trauma.
Originally published in: Nature Neuroscience, 2002, 5(11), 1242-1247.
In this case control study of monozygotic twins discordant for trauma exposure, Mark Gilbertson and six colleagues investigate important questions about size of hippocampus and vulnerability to trauma. The authors found that severe PTSD twin pairs -- both trauma-exposed and unexposed -- had significantly smaller hippocampi. Their results indicate that pre-existing hippocampal volume constitutes an independent risk factor for development of trauma-related psychopathology, and show one way that individual differences in vulnerability for PTSD (given a traumatic exposure) may appear. About 50 references. "
posted 11:50 p.m.
Early Childhod Trauma and Disorders of Extreme Stress as Predictors of Treatment Outcome with Chronic Posttraumatic Stress Disorder.
David Baldwin's Trauma Information, Articles:
Ford & Kidd (1998)
Early Childhod Trauma and Disorders of Extreme Stress as Predictors of Treatment Outcome with Chronic Posttraumatic Stress Disorder.
As published in the October 1998 issue of the Journal of Traumatic Stress, 11(4), 743-761.
Julian Ford investigated early trauma and DESNOS as contributing factors in treatment outcome, in this study of adult chronic PTSD inpatients. Although early trauma is correlated with a diagnosis of DESNOS, the authors found that DESNOS was a stronger predictor of treatment non-responding in this patient population. Implications for treatment planning are discussed. 74 references. "
Ford & Kidd (1998)
Early Childhod Trauma and Disorders of Extreme Stress as Predictors of Treatment Outcome with Chronic Posttraumatic Stress Disorder.
As published in the October 1998 issue of the Journal of Traumatic Stress, 11(4), 743-761.
Julian Ford investigated early trauma and DESNOS as contributing factors in treatment outcome, in this study of adult chronic PTSD inpatients. Although early trauma is correlated with a diagnosis of DESNOS, the authors found that DESNOS was a stronger predictor of treatment non-responding in this patient population. Implications for treatment planning are discussed. 74 references. "
posted 11:50 p.m.
Disorders of Extreme Stress Following Warzone Military Trauma: Associated Features of Post-traumatic Stress Disorder (PTSD) or Comorbid but Distinct S
David Baldwin's Trauma Information, Articles:
Ford (1999)
Disorders of Extreme Stress Following Warzone Military Trauma: Associated Features of Post-traumatic Stress Disorder (PTSD) or Comorbid but Distinct Syndromes?
As published in the February 1999 issue of Journal of Consulting and Clinical Psychology, 67(1), 3-12.
Julian Ford, at the National Center for PTSD, reports on important differences and similaries between the Posttraumatic Stress Disorder (PTSD) and Disorders of Extreme Stress (DESNOS) diagnostic categories, in a sample of 84 male military combat veterans seeking inpatient PTSD treatment. In this chronic sample, with depression and personalitiy disorders used as covariates, the two disorders were found to be comorbid but distinct post traumatic syndromes. Ford concludes that the combination of early childhood and atrocity trauma may best be understood in terms of DESNOS. Implications are discussed for assessment, classification, research and treatment. 56 references. "
Ford (1999)
Disorders of Extreme Stress Following Warzone Military Trauma: Associated Features of Post-traumatic Stress Disorder (PTSD) or Comorbid but Distinct Syndromes?
As published in the February 1999 issue of Journal of Consulting and Clinical Psychology, 67(1), 3-12.
Julian Ford, at the National Center for PTSD, reports on important differences and similaries between the Posttraumatic Stress Disorder (PTSD) and Disorders of Extreme Stress (DESNOS) diagnostic categories, in a sample of 84 male military combat veterans seeking inpatient PTSD treatment. In this chronic sample, with depression and personalitiy disorders used as covariates, the two disorders were found to be comorbid but distinct post traumatic syndromes. Ford concludes that the combination of early childhood and atrocity trauma may best be understood in terms of DESNOS. Implications are discussed for assessment, classification, research and treatment. 56 references. "
posted 11:50 p.m.
Posttraumatic Stress Disorder in a Community Sample of Former Prisoners of War: A Normative Response to Severe Trauma
David Baldwin's Trauma Information, Articles:
Engdahl, Dikel, Eberly & Blank (1997)
Posttraumatic Stress Disorder in a Community Sample of Former Prisoners of War: A Normative Response to Severe Trauma
Originally published in the American Journal of Psychiatry, 1997, 154(11), 1576-1581.
Brian Engdahl and colleagues interviewed a community sample of former prisoners-of-war (N = 262; WWII & Korea) living in the midwestern United States, comparing the incidence of posttraumatic stress disorder (PTSD) with other DSM Axis I disorders often found among trauma survivors. The most severely traumatized POW's had lifetime rates of 84% and current rates of 58% for PTSD; most of those with current PTSD were free from other Axis I disorders. Less than 10% of this sample was free of all PTSD symptoms. The authors conclude that PTSD is a normative and persistent consequence of exposure to severe trauma. "
Engdahl, Dikel, Eberly & Blank (1997)
Posttraumatic Stress Disorder in a Community Sample of Former Prisoners of War: A Normative Response to Severe Trauma
Originally published in the American Journal of Psychiatry, 1997, 154(11), 1576-1581.
Brian Engdahl and colleagues interviewed a community sample of former prisoners-of-war (N = 262; WWII & Korea) living in the midwestern United States, comparing the incidence of posttraumatic stress disorder (PTSD) with other DSM Axis I disorders often found among trauma survivors. The most severely traumatized POW's had lifetime rates of 84% and current rates of 58% for PTSD; most of those with current PTSD were free from other Axis I disorders. Less than 10% of this sample was free of all PTSD symptoms. The authors conclude that PTSD is a normative and persistent consequence of exposure to severe trauma. "
posted 11:50 p.m.
Conflict Between Current Knowledge About Posttraumatic Stress Disorder and its Original Conceptual Basis.
David Baldwin's Trauma Information, Articles:
Yehuda & McFarlane (1995)
Conflict Between Current Knowledge About Posttraumatic Stress Disorder and its Original Conceptual Basis.
Originally appeared in American Journal of Psychiatry, 1995, 152(12), 1705-1713.
Rachel Yehuda and Sandy McFarlane explore historical and social forces that have influenced our conception of trauma as a cause of PTSD, and they discuss current research findings with respect to these original conceptions. They conclude that we in the field must address contradictions between recent research and our previous conceptions of the PTSD disorder. Review article with 123 references. "
Yehuda & McFarlane (1995)
Conflict Between Current Knowledge About Posttraumatic Stress Disorder and its Original Conceptual Basis.
Originally appeared in American Journal of Psychiatry, 1995, 152(12), 1705-1713.
Rachel Yehuda and Sandy McFarlane explore historical and social forces that have influenced our conception of trauma as a cause of PTSD, and they discuss current research findings with respect to these original conceptions. They conclude that we in the field must address contradictions between recent research and our previous conceptions of the PTSD disorder. Review article with 123 references. "
posted 11:49 p.m.
Phenomenology and Psychobiology of the Intergenerational Response to Trauma.
David Baldwin's Trauma Information, Articles:
Yehuda, et al (1998)
"Phenomenology and Psychobiology of the Intergenerational Response to Trauma. Phenomenology and Psychobiology of the Intergenerational Response to Trauma.
Pre-publication text version of Chapter 37 (pp. 639-655) in Y. Danieli (Ed.) International Handbook: Multigenerational Legacies of Trauma. New York: Plenum Press, 1998.
In this draft chapter (a second revision, lacking the 5 figures), Rachel Yehuda and colleagues briefly review literature describing the effects of the Holocaust on its survivors and their offspring. They then describe three different approaches to studying PTSD symptoms in Holocaust survivors and adult offspring of Holocaust survivors, and report preliminary results from three in-progress studies. About 60 references. "
Yehuda, et al (1998)
"Phenomenology and Psychobiology of the Intergenerational Response to Trauma. Phenomenology and Psychobiology of the Intergenerational Response to Trauma.
Pre-publication text version of Chapter 37 (pp. 639-655) in Y. Danieli (Ed.) International Handbook: Multigenerational Legacies of Trauma. New York: Plenum Press, 1998.
In this draft chapter (a second revision, lacking the 5 figures), Rachel Yehuda and colleagues briefly review literature describing the effects of the Holocaust on its survivors and their offspring. They then describe three different approaches to studying PTSD symptoms in Holocaust survivors and adult offspring of Holocaust survivors, and report preliminary results from three in-progress studies. About 60 references. "
posted 11:48 p.m.
Pierre Janet and the Breakdown of Adaptation in Psychological Trauma.
David Baldwin's Trauma Information, Articles:
Van der Kolk & Van der Hart (1989)
Pierre Janet and the Breakdown of Adaptation in Psychological Trauma.
Originally appeared in American Journal of Psyciatry, 146 (12), 1530-1540 (December 1989).
In this article, Drs. Bessel van der Kolk and Onno van der Hart revisit the work of Pierre Janet, focusing particularly on his views regarding dissociation as a process that can transform overwhelming traumatic experiences into psychopathology. Specific attention is given to the processing and encoding of memory, and Janet's therapeutic principles. 100 references. "
Van der Kolk & Van der Hart (1989)
Pierre Janet and the Breakdown of Adaptation in Psychological Trauma.
Originally appeared in American Journal of Psyciatry, 146 (12), 1530-1540 (December 1989).
In this article, Drs. Bessel van der Kolk and Onno van der Hart revisit the work of Pierre Janet, focusing particularly on his views regarding dissociation as a process that can transform overwhelming traumatic experiences into psychopathology. Specific attention is given to the processing and encoding of memory, and Janet's therapeutic principles. 100 references. "
posted 11:45 p.m.
Thursday, February 01, 1990
Society for Neuroscience information:
Alcoholism
Bipolar Disorder
Depression
Insomnia
Phobia
Post-Traumatic Stress Disorder
Schizophrenia
.. nothing concerning DID
Alcoholism
Bipolar Disorder
Depression
Insomnia
Phobia
Post-Traumatic Stress Disorder
Schizophrenia
.. nothing concerning DID
posted 11:58 p.m.
Monday, January 01, 1990
Dissociable executive processes: Dissociable aspects of performance on the 5-choice serial reaction time task following lesions of the dorsal anterior
Entrez PubMed: "It is becoming increasingly apparent that multiple functions of the frontal cortex such as inhibitory control and executive attention are likely sustained by its functionally distinct and interacting sub-regions but the precise localization of dissociable executive processes has proved difficult and controversial. In the present series of studies, we investigated the behavioural effects of bilateral excitotoxic lesions of different regions of the rat neocortex in the 5-choice serial reaction time task. Whereas lesions of the dorsal anterior cingulate cortex (ACC) impaired performance of the task as revealed by a reduction in discriminative accuracy, lesions made to distinct ventral regions of the frontal cortex showed selective deficits in inhibitory measures of control. Specifically, the infralimbic lesion produced increases in premature responding that was accompanied by fast response latencies. By comparison, the orbitofrontal lesion showed perseverative tendencies particularly when the inter-trial interval was made long and unpredictable, a challenge that would normally promote premature responding instead. These different behavioural effects following dorsal and ventral lesions of the rodent frontal cortex signifies the integrity of the frontal cortex in multiple executive mechanisms that work independently and complementarily by which performance is optimized. Furthermore, these data provide new insights into the functional organization of the rodent frontal cortex with a particular emphasis on localization of function."
Dissociable aspects of performance on the 5-choice serial reaction time task following lesions of the dorsal anterior cingulate, infralimbic and orbitofrontal cortex in the rat: differential effects on selectivity, impulsivity and compulsivity.
Chudasama Y, Passetti F, Rhodes SE, Lopian D, Desai A, Robbins TW.
Behav Brain Res. 2003 Nov 30;146(1-2):105-19.
Erratum in:
Behav Brain Res. 2004 Jul 9;152(2):453.
Dissociable aspects of performance on the 5-choice serial reaction time task following lesions of the dorsal anterior cingulate, infralimbic and orbitofrontal cortex in the rat: differential effects on selectivity, impulsivity and compulsivity.
Chudasama Y, Passetti F, Rhodes SE, Lopian D, Desai A, Robbins TW.
Behav Brain Res. 2003 Nov 30;146(1-2):105-19.
Erratum in:
Behav Brain Res. 2004 Jul 9;152(2):453.
posted 11:57 p.m.
ADHD: NEUROSCIENCE OF ATTENTION-DEFICIT/HYPERACTIVITY DISORDER: THE SEARCH FOR ENDOPHENOTYPES
Nature Reviews Neuroscience - Reviews: "Research on attention-deficit/hyperactivity disorder (ADHD), a highly prevalent and controversial condition, has, for the most part, been descriptive and atheoretical. The imperative to discover the genetic and environmental risk factors for ADHD is motivating the search for quantifiable intermediate constructs, termed endophenotypes. In this selective review, we conclude that such endophenotypes should be solidly grounded in the neurosciences. We propose that three such endophenotypes -- a specific abnormality in reward-related circuitry that leads to shortened delay gradients, deficits in temporal processing that result in high intrasubject intertrial variability, and deficits in working memory -- are most amenable to integrative collaborative approaches that aim to uncover the causes of ADHD."
F. Xavier Castellanos & Rosemary Tannock
NEUROSCIENCE OF ATTENTION-DEFICIT/HYPERACTIVITY DISORDER: THE SEARCH FOR ENDOPHENOTYPES
Nature Reviews Neuroscience 3, 617-628 (2002); doi:10.1038/nrn896
F. Xavier Castellanos & Rosemary Tannock
NEUROSCIENCE OF ATTENTION-DEFICIT/HYPERACTIVITY DISORDER: THE SEARCH FOR ENDOPHENOTYPES
Nature Reviews Neuroscience 3, 617-628 (2002); doi:10.1038/nrn896
posted 11:56 p.m.
PTSD : PET imaging: Corticolimbic blood flow in posttraumatic stress disorder during script-driven imagery.
Entrez PubMed: "Functional neuroimaging experiments targeting personal recall of emotional events may help elucidate neural substrates underlying posttraumatic stress disorder (PTSD). Studies suggest that limbic and paralimbic function might be altered in PTSD, as compared with trauma-exposed control subjects; however, little is known about functional changes resulting from traumatic experience itself. The present study examined both PTSD-specific and trauma-specific regional cerebral blood flow (rCBF) patterns during script-driven imagery. . . Differential patterns of activation were detected in amygdala and medial frontal cortex. Past trauma experience was associated with decreased amygdala activity (i.e., less activity than healthy control subjects); however, combat control subjects deactivated this region (i.e., greater activity to neutral scripts). All subjects deactivated medial frontal cortex; PTSD patients had greater rostral anterior cingulate (rACC) deactivation compared with control groups, who deactivated ventromedial prefrontal cortex (vmPFC). Trauma-specific patterns may represent potential compensatory changes to traumatic reminders, while patterns observed only in the PTSD group may reflect neural substrates specific to PTSD pathophysiology."
Corticolimbic blood flow in posttraumatic stress disorder during script-driven imagery.
Britton JC, Phan KL, Taylor SF, Fig LM, Liberzon I.
Biol Psychiatry. 2005 Apr 15;57(8):832-40.
Corticolimbic blood flow in posttraumatic stress disorder during script-driven imagery.
Britton JC, Phan KL, Taylor SF, Fig LM, Liberzon I.
Biol Psychiatry. 2005 Apr 15;57(8):832-40.
posted 11:40 p.m.
Abuse: Abused Children Stay Highly Attuned To Anger
Abused Children Stay Highly Attuned To Anger: "Even the subtlest hints of anger or hostility in their environment sets physically abused children on prolonged 'alert', even if a conflict has nothing to do with them.
The tendency to stay attentive of nearby discord is probably a natural form of self-preservation in children who routinely face aggression. But it may also explain why abused children are often so distracted at school, write researchers from the University of Wisconsin-Madison, in the journal Child Development (September 14, 2005).
Led by Seth Pollak, a professor of psychology, psychiatry and pediatrics, the UW-Madison team tracked biological markers in 11 abused four and five-year olds who play a computer game in one room when suddenly a clearly audible, heated argument erupts between students next door.
Unbeknownst to the children, the "argument"- over an incomplete homework assignment - was actually a scripted dialogue performed by two actors.
Both abused and non-abused children initially displayed signs of emotional arousal-such as sweaty palms and decelerated heart rates--in reaction to the angry voices in the next room. Heart rates often decelerate prior to a "fight or flight" response, says Pollak, who is also a researcher at the UW-Madison Waisman Center for Human Development.
But though heart rates of non-abused subjects soon rose back to normal levels, heart rates in the abused group remained low-the abused children could not completely break their attention away from the next-door argument, even when it ended peacefully.
"What's really interesting about this experiment is that the abused children were taking their attention resources and redeploying them into something that had nothing to do with the children at all," says Pollak. "That provides an important clue about why these children are having interpersonal problems."
The UW-Madison work builds on past experiments in which Pollak has aimed to understand the developmental mechanisms that may lead abuse victims to adopt unhealthy behaviors later in life, such as aggression, social anxiety and addictions. "Several psychologists had put forward some very sophisticated theories about the outcomes of child abuse but no one had offered any brain-based cognitive models to explain why those outcomes occur," Pollak says.
Consequently, in 1999, Pollak showed that electrical brain activity spikes dramatically when abused children view digital images of angry faces. That result was not too surprising, he says. "Obviously, abused children's brains are doing exactly what they should be doing - they are learning to cope with their situation."
The latest work explores whether abused children react similarly to anger in real life situations, or in this case, experimental simulations of the real world. Pollak says the next step will be to discern exactly which neural systems and brain regions are most affected after physical abuse. "Knowing this specificity could help us figure out ways to eventually intervene in tailored ways.""
The tendency to stay attentive of nearby discord is probably a natural form of self-preservation in children who routinely face aggression. But it may also explain why abused children are often so distracted at school, write researchers from the University of Wisconsin-Madison, in the journal Child Development (September 14, 2005).
Led by Seth Pollak, a professor of psychology, psychiatry and pediatrics, the UW-Madison team tracked biological markers in 11 abused four and five-year olds who play a computer game in one room when suddenly a clearly audible, heated argument erupts between students next door.
Unbeknownst to the children, the "argument"- over an incomplete homework assignment - was actually a scripted dialogue performed by two actors.
Both abused and non-abused children initially displayed signs of emotional arousal-such as sweaty palms and decelerated heart rates--in reaction to the angry voices in the next room. Heart rates often decelerate prior to a "fight or flight" response, says Pollak, who is also a researcher at the UW-Madison Waisman Center for Human Development.
But though heart rates of non-abused subjects soon rose back to normal levels, heart rates in the abused group remained low-the abused children could not completely break their attention away from the next-door argument, even when it ended peacefully.
"What's really interesting about this experiment is that the abused children were taking their attention resources and redeploying them into something that had nothing to do with the children at all," says Pollak. "That provides an important clue about why these children are having interpersonal problems."
The UW-Madison work builds on past experiments in which Pollak has aimed to understand the developmental mechanisms that may lead abuse victims to adopt unhealthy behaviors later in life, such as aggression, social anxiety and addictions. "Several psychologists had put forward some very sophisticated theories about the outcomes of child abuse but no one had offered any brain-based cognitive models to explain why those outcomes occur," Pollak says.
Consequently, in 1999, Pollak showed that electrical brain activity spikes dramatically when abused children view digital images of angry faces. That result was not too surprising, he says. "Obviously, abused children's brains are doing exactly what they should be doing - they are learning to cope with their situation."
The latest work explores whether abused children react similarly to anger in real life situations, or in this case, experimental simulations of the real world. Pollak says the next step will be to discern exactly which neural systems and brain regions are most affected after physical abuse. "Knowing this specificity could help us figure out ways to eventually intervene in tailored ways.""
posted 11:36 p.m.
Memory: Multiple memory systems: the power of interactions.
Entrez PubMed: "Two relatively simple theories of brain function will be used to demonstrate the explanatory power of multiple memory systems in your brain interacting cooperatively or competitively to directly or indirectly influence cognition and behaviour. The view put forth in this mini-review is that interactions between memory systems produce normal and abnormal manifestations of behaviour, and by logical extension, an understanding of these complex interactions holds the key to understanding debilitating brain and psychiatric disorders."
Multiple memory systems: the power of interactions.
McDonald RJ, Devan BD, Hong NS.
Neurobiol Learn Mem. 2004 Nov;82(3):333-46.
Memory : Multiple memory systems: The power of interactions
Author Keywords: Interactions; Memory; Hippocampus; Dorsal striatum; Amygdala; Prefrontal cortex; Nucleus accumbens; Anxiety; Depression; Fear; Obsessive–compulsive disorder; Schizophrenia; Drug addiction; Drug abuse
NOTE: Despite discussing "multiple memory systems", the authors make no mention of DID in their keywords. This is yet another example of problematic diagnoses leading to erroneous reporting.
Multiple memory systems: the power of interactions.
McDonald RJ, Devan BD, Hong NS.
Neurobiol Learn Mem. 2004 Nov;82(3):333-46.
Memory : Multiple memory systems: The power of interactions
Author Keywords: Interactions; Memory; Hippocampus; Dorsal striatum; Amygdala; Prefrontal cortex; Nucleus accumbens; Anxiety; Depression; Fear; Obsessive–compulsive disorder; Schizophrenia; Drug addiction; Drug abuse
NOTE: Despite discussing "multiple memory systems", the authors make no mention of DID in their keywords. This is yet another example of problematic diagnoses leading to erroneous reporting.
posted 11:05 p.m.
Depression: The role of the hippocampus in the pathophysiology of major depression.
Entrez PubMed: "Converging lines of research suggest that the hippocampal complex (HC) may have a role in the pathophysiology of major depressive disorder (MDD). Although postmortem studies show little cellular death in the HC of depressed patients, animal studies suggest that elevated glucocorticoid levels associated with MDD may negatively affect neurogenesis, cause excitotoxic damage or be associated with reduced levels of key neurotrophins in the HC. Antidepressant medications may counter these effects, having been shown to increase HC neurogenesis and levels of brain-derived neurotrophic factor in animal studies. Neuropsychological studies have identified deficits in hippocampus-dependent recollection memory that may not abate with euthymia, and such memory impairment has been the most reliably documented cognitive abnormality in patients with MDD. Finally, data from imaging studies suggest both structural changes in the volume of the HC and functional alterations in frontotemporal and limbic circuits that may be critical for mood regulation. The extent to which such functional and structural changes determine clinical outcome in MDD remains unknown; a related, but also currently unanswered, question is whether the changes in HC function and structure observed in MDD are preventable or modifiable with effective treatment for the depressive illness."
The role of the hippocampus in the pathophysiology of major depression. Campbell S, Macqueen G.
J Psychiatry Neurosci. 2004 Nov;29(6):417-26.
Free Full Text Article
The role of the hippocampus in the pathophysiology of major depression. Campbell S, Macqueen G.
J Psychiatry Neurosci. 2004 Nov;29(6):417-26.
Free Full Text Article
posted 10:58 p.m.
Content
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