Transdiagnostic factors in the COVID-19 pandemic: Examining the role of childhood abuse and neglect in establishing latent profiles of risk and resilience.

BACKGROUND: Ample studies have focused on the negative consequences of COVID-19 on mental well-being, but fewer have explored the specific role of childhood abuse and neglect in the context of risk and resilience during this unprecedented crisis. OBJECTIVE: We aimed to identify distinct profiles of individuals based on their experiences of childhood abuse and neglect, coping strategies, and psycho-social transdiagnostic risk and protective factors, using a person-centered approach. PARTICIPANTS AND SETTING: A convenience sample of 914 Israelis completed self-report questionnaires during the second wave of COVID-19. METHODS: Latent Profile Analysis was employed based on levels of childhood abuse and neglect, coping strategies, and established factors underpinning risk and resilience in mental health: dissociation, self-criticism, self-efficacy, self-compassion, attachment insecurity, psychological resilience, mentalizing, distress disclosure, psychopathology, and relationship satisfaction. Profiles were compared in COVID-19-related distress and well-being using ANOVAs. RESULTS: A four-profile solution was found to be optimal for describing individuals with different profiles of risk and resilience: "risk" (5.1 %)-individuals with meaningfully high levels of childhood abuse and neglect and dissociation; "vulnerable" (14.2 %)-individuals high in risk factors and low in protective factors; "moderately resilient" (47.6 %)-those with moderate levels of protective and risk factors; "highly resilient" (33.1 %)-individuals high in protective factors and low in risk factors; groups differed in mental well-being and COVID-19-related distress. CONCLUSIONS: Results highlight the importance of childhood abuse and neglect in differentiating between the two distinct profiles of at-risk individuals. Implications for risk assessment and treatment in the context of potential traumatic stress are discussed.

Reciprocal associations between early maladaptive schemas and depression in adolescence: long-term effects of childhood abuse and neglect.

BACKGROUND: Adolescent depression has grown to be a major social concern in China. During the coronavirus pandemic, the incidence of depression among Chinese adolescents increased substantially. More research is required to inform the prevention and intervention of adolescent depression in China. Depression is associated with Early Maladaptive Schemas (EMSs). Childhood abuse and neglect are distal antecedents of adolescent depression. It is not known how depression and EMSs interact in adolescence and how childhood abuse and neglect contribute to this relationship. This study aimed to examine the reciprocal relationships between depression and EMSs, as well as the long-term effects of childhood abuse and neglect on depression and EMSs during adolescence. The work also investigates gender differences in these mechanisms. METHODS: Using a two-wave longitudinal design, we recruited 3,485 Chinese adolescents (Mage = 13.2; 43.2% females) from three Shanxi Province, China middle schools. All participants completed self-report questionnaires addressing childhood abuse and neglect, depression, and EMSs. Structural equation models examined reciprocal relationships between depression and EMS, as well as the effect of childhood abuse and neglect on depression and EMSs. Multi-group analysis addressed gender differences. RESULTS: Results indicated that greater depression predicted more EMSs measured later, but EMSs did not predict subsequent depression. Childhood abuse and neglect had different effects on depression and EMSs during adolescence. Specifically, exposure to childhood abuse related to more severe depression and EMSs in adolescence and contributed to the perpetuation of EMSs by increasing depression. Exposure to childhood neglect showed a direct effect on depression and indirectly reinforced subsequent EMSs through depression. There were no gender differences. CONCLUSION: These findings contribute to a better understanding of the emergence and course of depression in early adolescence, suggesting that childhood abuse and neglect are critical early risk factors. Additionally, depression plays a key role in promoting schema perpetuation among adolescents exposed to childhood maltreatment, providing important implications for relevant prevention and intervention in early adolescence.

Accuracy and Bias in Facial Trustworthiness Appraisals in Borderline Personality Disorder.

Individuals with borderline personality disorder (BPD) have shown a negativity bias, whereas the general population has shown a positivity bias in their trustworthiness appraisal of others. We tested if individuals with BPD are more negative but also more realistic with their appraisals. Trustworthiness was objectified on an external criterion. The influence of childhood trauma was investigated. Facial photographs of peace prize laureates and sentenced murderers were presented. Participants with BPD and healthy controls (HC) rated the trustworthiness of the targets. Bias and sensitivity were measured using signal detection theory. The BPD group was more negatively biased compared to HC, but not more sensitive in discriminating between the two groups. When correcting for experienced childhood abuse and neglect, the authors found that group differences in bias disappeared. Individuals with BPD might not be more sensitive in discriminating between, on average, more or less trustworthy targets, but they have developed a negativity bias to ensure the detection of untrustworthiness.

Parental mentalising among mothers with intellectual disability or ADHD: Links with experiences of abuse, neglect and psychosocial risk.

BACKGROUND: Parental mentalising difficulties are robustly linked to caregiving problems. Mothers with intellectual disability are at risk for caregiving problems, but knowledge on their parental mentalising abilities is lacking. The present study aimed to fill this gap. METHOD: Thirty mothers with mild intellectual disability, and 61 comparison mothers with ADHD, were assessed for parental mentalising using the Parental Reflective Functioning Questionnaire. Contributions of intellectual disability, maternal exposure to childhood abuse/neglect and psychosocial risk to parental mentalising were examined through hierarchical regression analysis. RESULTS: Mothers with intellectual disability had a heightened risk for parental mentalising difficulties, in the form of elevated prementalising. Intellectual disability and cumulative childhood abuse/neglect uniquely predicted prementalising among the mothers, whereas cumulative psychosocial risk added to the risk for prementalising specifically among mothers with intellectual disability. CONCLUSIONS: Our findings support contextual models of caregiving, and suggest a need for mentalisation-based support for parents with mild intellectual disability.

Association between the behavioral response during social exclusion and recalled childhood maltreatment.

Social exclusion is a critical event for mental health. Patients with interpersonal dysfunction, e.g., with borderline personality disorder (BPD) or persistent depressive disorder (PDD), are particularly vulnerable, often based on their experiences of early adversity in life. The etiological pathways from childhood maltreatment (CM) to current behavior during social exclusion are still underexplored. This cross-diagnostic study investigated the relationship between self-reported CM and behavioral reaction to social exclusion in an experimental paradigm (Cyberball). Data from 140 subjects including patients with BPD and PDD as well as healthy controls were analyzed. The effect of CM (Childhood Trauma Questionnaire, CTQ) on behavior to social exclusion during Cyberball (ball tossing behavior) was analyzed including rejection sensitivity (RS) as a mediator. In the whole sample, the CTQ score (B = -.004, p < .05) as well as the emotional neglect subscore (B = -.016, p < .01) were associated with a reduced ball tossing behavior towards the excluder. There were no significant indirect effects involving RS. These current findings support the relationship between CM and an altered interpersonal response in critical interpersonal situations. Larger cohorts with multidimensional data in social domains are warranted to further investigate the link between CM and current interpersonal dysfunction.

Adolescent maladaptive schemas and childhood abuse and neglect: A systematic review and meta-analysis.

This study aimed to review evidence on the associations between childhood emotional, physical and sexual abuse; neglect and bullying and early maladaptive schemas, as measured in adolescence. PubMed, PsycInfo and CINAHL were searched to identify peer-reviewed studies reporting original quantitative data on the association between early maladaptive schemas or schema domains (e.g., Disconnection and Rejection) and childhood emotional, physical and sexual abuse; neglect and bullying, measured in individuals aged up to 18 years. Meta-analyses were conducted to estimate the magnitude of the associations between schemas and childhood experiences. Twelve studies were included: Seven explored schemas, and five examined schema domains. Most studies had somewhat representative samples that were adequate in size, and all used validated measures of schemas or schema domains. Three studies explored emotional neglect, two each for emotional abuse, physical abuse and peer problems, one explored family violence and one adolescent stressors. Meta-analyses indicated small to medium pooled associations between emotional abuse and Emotional Deprivation, r = .33 (95% CI [.19, .46]) and Subjugation, r = .32 (95% CI [.14,.47]) and emotional neglect and Mistrust Abuse, r = .41 (95% CI [.32, .49]), Abandonment, r = .25 (95% CI [.22, .28]), Social Isolation r = .23 (95% CI [.10, .35]) and Failure, r = .35 (95% CI [.26, .44]). Associations between childhood abuse and neglect experiences and schemas were evident in adolescents. There were limited data on some adverse experiences including sexual abuse and neglect. The evidence thus far suggests that maladaptive schemas are related to experiences of childhood emotional abuse and neglect and are evident before adulthood.

Childhood abuse and neglect experiences, Hostile-Helpless attachment, and reflective functioning in mentally ill filicidal mothers.

The present study represents the first empirical investigation of the mechanisms - a Hostile-Helpless (HH) attachment and reflective functioning (RF) - through which childhood abuse and neglect (CA&N) experiences may impact a mother's likelihood to commit filicide. The sample was comprised of 46 mentally ill mothers. Differences in attachment-derived risk variables between filicidal mothers (FM) and non-filicidal mothers (NFM) were also examined. FM (n = 23) reported lower RF, higher HH attachment, and a more severe history of CA&N, compared to NFM (n = 23), but did not differ on the severity of childhood experiences of loss of and/or separation from attachment figures. Bayesian analysis indicated that the mediated effect of more severe CA&N on the likelihood of committing filicide through higher HH attachment was significantly amplified by lower RF. A developmental interpretation of filicide is proposed and clinical implications for prevention and attachment-based interventions with at-risk mother-child dyads are discussed.

Life stress, early maltreatment, and prospective associations with depression and anxiety in preadolescent children: A six-year, multi-wave study.

BACKGROUND: The relationship between life stress and depression and anxiety is well characterized in adolescents and adults. Further, research has shown that adolescents and adults with a history of childhood maltreatment are more likely to develop depression and anxiety after being exposed to stress than those without this history. However, the processes underlying risk for depression and anxiety in maltreated preadolescent children are unclear. The current study sought to identify these processes in at-risk preadolescents. METHODS: This study analyzed data from the Longitudinal Studies of Child Abuse and Neglect and evaluated interpersonal and non-interpersonal life stress as predictors of depression and anxiety specifically, and internalizing symptoms more generally, in a sample of children vulnerable or exposed to maltreatment (n = 1,049). Participants were assessed repeatedly over a six-year period of early-to-mid childhood. RESULTS: Interpersonal life stress prospectively predicted greater depression and anxiety, but not general internalizing symptoms after emotional and behavioral problems, as well as child's sex, family income and baseline maternal depressive symptoms, were covaried. Non-interpersonal life stress was not prospectively predictive of depression and anxiety or general internalizing symptoms. LIMITATIONS: The study was unable to identify specific types of interpersonal stress most relevant to risk for depression and anxiety in preadolescent children. CONCLUSIONS: These findings lend support for the importance of interpersonal stress when screening for risk for depression and anxiety among preadolescent children vulnerable or exposed to maltreatment. Early intervention to decrease the occurrence and impact of these stressors could have long-lasting impacts on this vulnerable population.

Emotion Regulation as a Mediator between Childhood Abuse and Neglect and Posttraumatic Stress Disorder in Women with Substance Use Disorders.

OBJECTIVE: A history of childhood abuse and neglect (CAN) is significantly associated with psychopathologies in adulthood, including comorbid posttraumatic stress disorder (PTSD) and substance use disorders (SUD). Difficulties in emotion regulation (ER) might influence the association between CAN and PTSD. The aim of this study was to examine the relationship between CAN and PTSD symptom severity in women with SUD and to investigate the mediating role of general difficulties in ER and its specific dimensions. Method: We examined 320 women, with a current diagnosis of at least subsyndromal PTSD and SUD, using self-report measures of CAN, PTSD symptom severity, and ER difficulties. We conducted both simple and multiple bootstrapping-enhanced mediation analysis to investigate whether general difficulties in ER and its specific dimensions mediate the relationship between CAN and PTSD symptom severity. Results: General difficulties in ER mediated the association between CAN and PTSD symptom severity. CAN significantly predicted adult PTSD symptom severity, directly and indirectly, through ER difficulties. Difficulties engaging in goal directed behavior when distressed was the only ER dimension, which mediated the effect of CAN on PTSD symptoms. Conclusions: Our results suggest that difficulties in ER and specifically difficulties engaging in goal directed behavior when distressed might constitute an influential factor in the relationship between CAN and PTSD symptom severity in a sample of SUD patients, and highlight the importance of targeting ER as a potential treatment focus for patients with comorbid PTSD and SUD.

Use of the Whole Child Assessment to identify children at risk of poor outcomes.

BACKGROUND: Screening for Adverse Childhood Experiences (ACEs) in pediatric patients has the potential to prevent poor health outcomes associated with ACEs. Only a limited number of tools screen for all ten ACEs in all pediatric age groups, and none of these have demonstrated robust validity to date. OBJECTIVE: In order to evaluate the validity of the Whole Child Assessment, we examined associations between poor outcomes in pediatric patients and responses to questions about exposure to and risk of ACEs. METHODS: This cross-sectional study used medical record data from 499 children ages 5-11 years old who received care at one of two university-affiliated clinics in California. All Child-ACE measures were included on the Whole Child Assessment, which caregivers completed when they brought their child to a well-child visit. Medical charts were reviewed for current diagnoses and problems, current or past history of any developmental delay, and health care utilization. RESULTS: Compared to lower risk patients (0-1 reported ACE exposure), patients with 2 or more reported exposures were statistically significantly more likely to experience sadness, anger, sleep problems, bullying, school problems, and enuresis. The directionality of effects and the number of statistically significant associations improved when adding questions about risk of ACEs to the total Child-ACE score. CONCLUSION: We found strong relationships between Child-ACEs reported on the Whole Child Assessment and odds of poor child health and psychosocial outcomes in pediatric patients age 5-11 years old, which supports the validity of using the Whole Child Assessment at well-child visits.

Associations between adverse childhood experiences and adversities later in life. Survey data from a high-risk Norwegian sample.

BACKGROUND: A history of childhood abuse and neglect (CAN) is associated with exposure to later negative life events. CAN at an early age, multiple cooccurring exposures (cumulative events), and a high severity and frequency of exposure have potential detrimental long-term effects. OBJECTIVE: The present study examines the relationship between the severity of CAN and the prevalence of school difficulties and hardship at school, adult adversity and mental health. PARTICIPANTS AND SETTINGS: Participants were recruited from in- and outpatient mental health or substance abuse treatment facilities, child protective services (CPS), and prisons (N = 809, age range = 13-66, mean age = 27.62, SD = 10.47). METHODS: Exposure to childhood maltreatment was assessed by the Childhood Trauma Questionnaire Short Form (CTQ-SF). After adjusting for gender and age, we conducted a risk ratio regression analysis to investigate associations between severity of child abuse and neglect and hardship at school, adult adversity and adult mental health. RESULTS: The moderate and severe level groups of CAN had statistically significant higher risk ratios for experiences of school difficulties, hardship at school, adult adversity and mental health problems. A robust dose-response was found between severity levels. CONCLUSION: At an individual level the findings highlight the association between exposure to abuse and adult adversity, underscoring the importance of targeting individuals with high risk of exposure to CAN to reduce the negative long-term risk for Polyvictimization.

Childhood Trauma and Dissociative Intimate Partner Violence.

The present study assesses childhood abuse/neglect as a predictor of dissociative intimate partner violence (IPV) among 118 partner-abusive men. One third (36%) endorsed dissociative IPV, most commonly losing control (18%), surroundings seeming unreal (16%), feeling someone other than oneself is aggressing (16%), and seeing oneself from a distance aggressing (10%). Childhood physical abuse/neglect predicted IPV-specific derealization/depersonalization, aggressive self-states, and flashbacks to past violence. Childhood emotional abuse/neglect predicted derealization/depersonalization, blackouts, and flashbacks. Childhood sexual abuse uniquely predicted amnesia. Other potential traumas did not predict dissociative IPV, suggesting dissociative IPV is influenced by trauma-based emotion dysregulation wherein childhood abuse/neglect survivors disconnect from their abusive behavior.

Child Abuse and Neglect, and Psychiatric Disorders in Nonviolent and Violent Female Offenders.

Although the percentage of crimes committed by females has increased over the last 20 years in the United States, most research focuses on crimes by males. This article describes an examination of the extent to which childhood maltreatment predicts violent and nonviolent offending in females and the role of psychiatric disorders. Using data from a prospective cohort design study, girls with substantiated cases of physical and sexual abuse and neglect were matched with nonmaltreated girls (controls) on the basis of age, race, and approximate family socioeconomic class, and followed into adulthood (N = 582). Information was obtained from official arrest records and participant responses to a standardized structured psychiatric interview. Women with a history of any childhood maltreatment, physical abuse, sexual abuse, and neglect were at significantly increased risk for having an arrest for violence, compared to control women. Except for those with a history of physical abuse, abused and neglected women were also at increased risk for arrest for a nonviolent crime, compared to controls. In bivariate chi-square comparisons, the three groups of women (violent offenders, nonviolent offenders, and nonoffenders) differed significantly in the diagnoses of posttraumatic stress disorder (PTSD), alcohol abuse, drug abuse, and dysthymia, but not major depressive disorder, and violent female offenders had significantly higher rates of these disorders compared to nonoffenders. However, with controls for age and race, PTSD was the only psychiatric disorder to distinguish women arrested for a violent crime compared to a nonviolent crime (adjusted odds ratio [AOR] = 6.32, confidence interval [95% CI] = 1.84-21.68, p < 0.01), and PTSD moderated the relationship between childhood maltreatment and violent offending (AOR = 5.55, 95% CI = 1.49-20.71): women with histories of childhood maltreatment were equally likely to have an arrest for violence, regardless of PTSD diagnosis, whereas having a diagnosis of PTSD increased the risk of violence for women without maltreatment histories. Together, these findings suggest two pathways to violent offending among females-one through childhood maltreatment and a second through PTSD. Implications of these findings are discussed.

Italian translation and cross-cultural comparison with the Childhood Attachment and Relational Trauma Screen (CARTS).

Background: The Childhood Attachment and Relational Trauma Screen (CARTS) is a computer-administered survey designed to assess retrospectively the socio-ecological context in which instances of child abuse may have occurred. To date, studies supporting the validity of the CARTS have only been undertaken in English-speaking North American populations. Validation projects in other countries and cross-cultural comparisons are therefore warranted. Objective: Develop and preliminarily evaluate the psychometric properties of an Italian version of the CARTS on college students and compare such observations to data acquired from Canadian students. Method: Seventy-nine undergraduate students from the University of Padua (Italy) completed an Italian translation of the CARTS as well as measures of childhood experiences, mental health and attachment, responses to which were compared to those obtained in 288 Canadian students who completed the CARTS in English. Results: Internal consistency and convergent validity with the Childhood Trauma Questionnaire and Parental Bonding Instrument were found to be acceptable for the Italian translation. Within the Italian sample, correlation analyses suggested that CARTS Mother ratings referring to attachment and abuse were associated with romantic attachment, whereas CARTS Father ratings were significantly correlated to PTSD symptoms and other symptoms of psychopathology-distress. Significant differences between Italian and Canadian students across the relationship types for the CARTS abuse and attachment scales were found, indicating that Italian students rated their mothers and fathers as simultaneously less abusive, but also less as a source of secure attachment. Conclusions: The results of this preliminary study seem to suggest convergent validity of the Italian CARTS and the association between childhood attachment-related experiences and romantic attachment. Cultural variations were identified between Canadian and Italian students in both attachment and abuse scales. Future studies to investigate cross-cultural variations in the relational context of childhood abuse and in order to boost Italian CARTS psychometric features are warranted.

Planteamiento: La Encuesta de Apego Infantil y Trauma Relacional (CARTS) es una encuesta administrada por ordenador diseñada para evaluar retrospectivamente el contexto socio-ecológico en el que pueden haber ocurrido casos de abuso infantil. Hasta la fecha, los estudios que apoyan la validez de la CARTS sólo se han realizado en poblaciones norteamericanas de habla inglesa. Por lo tanto, se justifican los proyectos de validación en otros países y las comparaciones interculturales. Objetivos: Desarrollar y evaluar de manera preliminar las propiedades psicométricas de una versión italiana de CARTS en estudiantes universitarios y comparar dichas observaciones con datos obtenidos de estudiantes canadienses. Método: Setenta y nueve estudiantes de pre-grado de la Universidad de Padua (Italia) completaron una traducción al italiano de la CARTS, así como medidas de experiencias infantiles, salud mental y apego. Las respuestas fueron comparadas con las obtenidas en 288 estudiantes canadienses que completaron la CARTS en inglés. Resultados: Se encontró que la coherencia interna y la validez convergente con el Cuestionario de Trauma Infantil (Childhood Trauma Questionnaire) y el Instrumento de Vinculación Parental (Parental Bonding Instrument) eran aceptables para la traducción al italiano. Dentro de la muestra italiana, los análisis de correlación sugirieron que las puntuaciones de la CARTS-Madre que se refieren al apego y al abuso se asociaron con el apego romántico, mientras que las puntuaciones de la CARTS-Padre se correlacionaron significativamente con síntomas de TEPT y otros síntomas de trastorno psicopatológico. Se encontraron diferencias significativas entre los estudiantes italianos y canadienses entre los tipos de relación para las escalas de abuso y apego de la CARTS, lo que indica que los estudiantes italianos clasificaron a sus madres y padres simultáneamente como menos abusivos, pero también menos como fuente de apego seguro. Conclusiones: Los resultados de este estudio preliminar parecen sugerir la validez convergente de la CARTS italiana y la asociación entre las experiencias relacionadas con el apego infantil y el apego romántico. Se identificaron variaciones culturales entre estudiantes canadienses e italianos en las escalas de apego y abuso. Se justifican la realización de futuros estudios para investigar las variaciones interculturales en el contexto relacional del abuso infantil y con el fin de impulsar las características psicométricas de la CARTS italiana.

Childhood maltreatment in children born of occupation after WWII in Germany and its association with mental disorders.

BACKGROUND: Children born of war are a common phenomenon of conflict. In the aftermath of World War II, more than 200,000 German occupation children (GOC) were fathered by occupation soldiers and born to local women. GOC often grew up under difficult conditions and showed high prevalence rates of mental disorders even decades later. METHODS: Experiences of childhood maltreatment and their association with Posttraumatic Stress Disorder (PTSD), depression, and somatization in GOC (N = 146) are investigated and compared with a representative birth-cohort-matched sample (BCMS) from the German general population (N = 920). RESULTS: Outcomes show significantly higher prevalence rates of emotional abuse/neglect, physical, and sexual abuse in GOC compared to BCMS. All five subtypes of childhood maltreatment increase the risk of PTSD and somatoform syndrome; depressive syndromes are associated with emotional abuse/neglect and physical abuse. GOC were at high risk of childhood maltreatment. CONCLUSIONS: Findings underline the complex, long-term impact of developmental conditions and childhood maltreatment on mental disorders even decades later.

The global collaboration on traumatic stress.

Trauma is a global issue. The great majority of the global burden of disease arising from mental health conditions occurs in low- and middle-income countries (LMICs), among populations in political, economic, and/or cultural transition and those struck by forced migration. These mental health problems frequently arise as a result of traumatic events that adversely affect adults, children, and families, including war, mass violence, natural disasters, and accidents. In response to this, the International Society for Traumatic Stress Studies (ISTSS) launched the Global Initiative to have a stronger global impact on trauma-related issues. As part of this initiative, the Global Collaboration was established by representatives of eight professional organizations active in the field of traumatic stress. The group decided to focus on childhood abuse and neglect as its first collaboration. They collected guidelines worldwide, providing the basis for a synthesized core guide for prevention and treatment that can be customized for specific cultural contexts. The resulting 'Internet information on Childhood Abuse and Neglect' (iCAN) is a comprehensive guide for adults who have been affected by childhood abuse and neglect, as well as for the survivors' significant others. It is currently provided in eight languages, and is freely available at the homepage of ISTSS and other websites. A second achievement of the Global Collaboration is the validation of the Computerized Childhood Attachment and Relational Trauma Screen (CARTS), a self-report measure designed to measure occurrences of childhood maltreatment, and its translation into multiple languages, including Croatian, Dutch, French, Georgian, German, Italian, Japanese, Norwegian, Russian, and Spanish. A study is currently planned to collect normative responses to the questionnaire, and to conduct cross-cultural comparisons. The Global Collaboration's success may be seen as an encouraging step towards a truly global structure in the field of traumatic stress.

El trauma es un problema global. La gran mayoría de la carga mundial de enfermedades derivadas de las enfermedades de salud mental se produce en los países de ingresos medios y bajos (PIMB), entre las poblaciones en transición política, económica y/o cultural y las afectadas por la migración forzada. Estos problemas de salud mental suelen surgir como resultado de acontecimientos traumáticos que afectan de modo adverso a adultos, niños y familias, e incluyen guerras, violencia masiva, desastres naturales y accidentes. En respuesta a esto, la Sociedad Internacional de Estudios de Estrés Traumático (ISTSS) lanzó la Iniciativa Global para tener un impacto global más fuerte en los temas relacionados con el trauma. Como parte de esta iniciativa, la Colaboración Global fue establecida por representantes de ocho organizaciones profesionales activas en el campo del estrés traumático. El grupo decidió centrarse en el abuso y la negligencia infantil como primera colaboración. Recopilaron directrices de todo el mundo, proporcionando la base para un guía central sintetizada de prevención y tratamiento que se puede personalizar para contextos culturales específicos. La 'información de Internet sobre abuso y abandono infantil' (iCAN) resultante es una guía completa para adultos que se han visto afectados por abuso y negligencia en la infancia, así como para los seres queridos de los sobrevivientes. Actualmente, se ofrece en ocho idiomas y está disponible gratuitamente en la página de inicio de la ISTSS y otras páginas web. Un segundo logro de la Colaboración Global es la validación de la Detección Computarizada de Apego Infantil y Trauma Relacional (CARTS), una medida de autoinforme diseñada para medir las ocurrencias de maltrato infantil, y su traducción a múltiples idiomas, que incluyen croata, holandés, francés, georgiano, alemán, italiano, japonés, noruego, ruso y español. Actualmente se está planeando un estudio para recopilar respuestas normativas al cuestionario y realizar comparaciones interculturales. El éxito de la Colaboración Global puede verse como un paso estimulante hacia una verdadera estructura global en el campo del estrés traumático.

Trauma-Related Altered States of Consciousness (TRASC) and Functional Impairment I: Prospective Study in Acutely Traumatized Persons.

A theoretical framework referred to as a 4-D model has been described for classifying posttraumatic stress symptoms into those potentially occurring within normal waking consciousness (NWC) versus those thought to intrinsically exemplify dissociative experiences, specifically, trauma-related altered states of consciousness (TRASC). As a further test of this theoretical distinction, this prospective study evaluated whether TRASC and NWC forms of distress incrementally and prospectively predicted functional impairment at 6 and 12 weeks following presentation at hospital emergency departments in the acute aftermath of traumatic events in 180 persons. Establishing the clinical significance of both TRASC and NWC-distress symptoms, we found that 6-week markers of TRASC and NWC-distress independently predicted 12-week self-reported levels of social and occupational impairment. We also observed broad support for various predictions of the 4-D model except that, in contrast with hypotheses, childhood trauma history was generally more strongly correlated with symptoms of NWC-distress than with TRASC. Future research directions are discussed.

Trauma-Related Altered States of Consciousness (TRASC) and Functional Impairment II: Perceived Causal Relationships in an Online Sample.

Research supports the existence of a dissociative subtype of posttraumatic stress disorder, although studies have not directly compared the perceived impact of dissociative versus nondissociative posttraumatic symptoms on social and occupational functioning. In addition, research is beginning to differentiate between posttraumatic distress associated with normal waking consciousness (NWC) and dissociative experiences of trauma-related altered states of consciousness (TRASC) along multiple phenomenological dimensions. The current study investigated perceived causal relationships between posttraumatic symptoms associated with NWC-distress and TRASC on the one hand and interpersonal and occupational functioning on the other. Although both TRASC and NWC-distress independently accounted for variance in self-reported interpersonal and occupational problems, perceived causal relationship results showed that individuals tended to attribute their social and work-related problems more strongly to NWC-distress than to TRASC. Future research directions are discussed.

Assessing the family dynamics of childhood maltreatment history with the Childhood Attachment and Relational Trauma Screen (CARTS).

BACKGROUND: Existing survey measures of childhood trauma history generally fail to take into account the relational-socioecological environment in which childhood maltreatment occurs. Variables such as the relationship between the perpetrator and the victim, the emotional availability of caregivers, witnessing the abuse of others, and the respondent's own thoughts, feelings, and actions in response to maltreatment are rarely assessed by current measures. METHODS: To address these concerns, the current study further investigated the family dynamics of childhood maltreatment using the Childhood Attachment and Relational Trauma Screen (CARTS) in 1,782 persons assessed online. RESULTS: Paired differences in means between item-rated descriptiveness of self, mothers, and fathers suggested that respondents' relationship with their biological fathers was less positive and secure than their relationship with their biological mothers, and that biological fathers were more often the perpetrator of emotional, physical, and sexual abuse than biological mothers. However, results further suggested that ratings between self, mothers, and fathers were positively correlated such that, for example, reports of a mother's or a respondent's own abusive behavior were more likely in the presence of reports of a father's abusive behavior. In addition, analyses evaluating witnessing violence demonstrated that fathers were rated as more often violent toward mothers than the reverse, although intimate partner violence was also frequently bidirectional. Analyses of sibling ratings further demonstrated that older brothers were either as or more frequently abusive when compared with parents. Finally, results suggested that childhood emotional, physical, and sexual abuse were much more often perpetrated by family members than extra-familial and non-family members. CONCLUSIONS: In so far as these findings are consistent with the prior childhood trauma and attachment literature, the current study further supports the utility of the CARTS as a means of assessing the family dynamics of childhood attachment and maltreatment within a relational-socioecological framework.